Editorial article
Bronchiectasis: The disease that was never orphan
Bronquiectasias: la enfermedad que nunca fue huérfana
Miguel Ángel Martínez-García
Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:24 [ "pii" => "S2387020621006148" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.11.001" "estado" => "S300" "fechaPublicacion" => "2021-12-24" "aid" => "5788" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2021;157:580-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775321005078" "issn" => "00257753" "doi" => "10.1016/j.medcli.2021.09.004" "estado" => "S300" "fechaPublicacion" => "2021-12-24" "aid" => "5788" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2021;157:580-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Bronquiectasias: la enfermedad que nunca fue huérfana" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "580" "paginaFinal" => "582" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bronchiectasis: The disease that was never orphan" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Ángel Martínez-García" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Martínez-García" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621006148" "doi" => "10.1016/j.medcle.2021.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006148?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321005078?idApp=UINPBA00004N" "url" => "/00257753/0000015700000012/v1_202112010528/S0025775321005078/v1_202112010528/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2387020621006161" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.04.013" "estado" => "S300" "fechaPublicacion" => "2021-12-24" "aid" => "5733" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2021;157:583-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Treatment of haemophilia: From replacement to gene therapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "583" "paginaFinal" => "587" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la hemofilia: de la terapia sustitutiva a la terapia génica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1644 "Ancho" => 2508 "Tamanyo" => 210379 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic diagram of coagulation and mechanism of action of new non-replacement agents in haemophilia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José A. Páramo" "autores" => array:1 [ 0 => array:2 [ "nombre" => "José A." "apellidos" => "Páramo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006161?idApp=UINPBA00004N" "url" => "/23870206/0000015700000012/v1_202112201710/S2387020621006161/v1_202112201710/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020621006173" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.10.020" "estado" => "S300" "fechaPublicacion" => "2021-12-24" "aid" => "5536" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2021;157:575-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Decreased DNA hydroxymethylation and increased DNA demethylation are associated with high antioxidant response in systemic lupus erythematosus patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "579" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación entre la disminución de hidroximetilación y el incremento de la desmetilación del ADN y la respuesta antioxidante en los pacientes de lupus eritematoso sistémico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2934 "Ancho" => 3167 "Tamanyo" => 282850 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Relationship of serum levels of SOD (A), GSH (B) and GSSG (C) with SLICC-ACR score in SLE patients.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jorge Juan Fragío Gil, Elena Grau García, Meritxell Fernández Matilla, Francisco Miguel Ortiz Sanjuan, Regina Rodrigo Nicolás, José Andrés Román Ivorra" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jorge Juan" "apellidos" => "Fragío Gil" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Grau García" ] 2 => array:2 [ "nombre" => "Meritxell" "apellidos" => "Fernández Matilla" ] 3 => array:2 [ "nombre" => "Francisco Miguel" "apellidos" => "Ortiz Sanjuan" ] 4 => array:2 [ "nombre" => "Regina" "apellidos" => "Rodrigo Nicolás" ] 5 => array:2 [ "nombre" => "José Andrés" "apellidos" => "Román Ivorra" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775320308770" "doi" => "10.1016/j.medcli.2020.10.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320308770?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006173?idApp=UINPBA00004N" "url" => "/23870206/0000015700000012/v1_202112201710/S2387020621006173/v1_202112201710/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Bronchiectasis: The disease that was never orphan" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "580" "paginaFinal" => "582" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Miguel Ángel Martínez-García" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Miguel Ángel" "apellidos" => "Martínez-García" "email" => array:1 [ 0 => "mianmartinezgarcia@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bronquiectasias: la enfermedad que nunca fue huérfana" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bronchiectasis, understood as dilatation of the bronchial lumen, was first described in the early 19th century by Laënnec. This disease has claimed millions of lives ever since, especially in times of pandemics generated by microorganisms that cause severe pulmonary damage, such as tuberculosis. Luckily, the number of diagnoses and deaths related to this disease decreased dramatically with the surge of preventive medicine and antibiotic therapy during the 20th century. However, far from becoming extinct, bronchiectasis has continued to be present to date, albeit with other forms of radiological presentation that could not be diagnosed without the appropriate imaging methods that are currently available. It is now a well-known fact that this entity can impact the patients’ prognosis and the evolution of the underlying disease that caused it.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This became evident when, at the beginning of the 1980s of the last century, a very significant increase was observed in the number of diagnoses of bronchiectasis of varying etiologies. These included, on the one hand, the omnipresent tuberculosis and the emergence of the pandemic of human immunodeficiency virus (HIV) infections. On the other, the increasing longevity of the population, which allowed bronchiectasis-generating diseases to be able to cause this entity before the patients’ death. And, finally, the increasing variety of immunosuppressive drugs that were highly effective for the treatment of certain diseases, but, in turn, favored pulmonary infections.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However, there were two predominant causes of this increase in the number of diagnoses of bronchiectasis. In the first place, the awareness of the existence of this entity following Cole's description of its causative pathophysiological mechanism (Cole's vicious circle).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> On the second hand, and of particular relevance, the massive use of thoracic computed tomography (particularly high-resolution computed tomography [HRCT], which is the gold standard in the diagnosis of this condition), which allowed clinicians to examine the pulmonary parenchyma and airways with unprecedented accuracy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As a result of the significant increase in the number of diagnoses of this condition and the certainty that it was associated with a worse prognosis in both patients and their underlying diseases, various national<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> and international<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> patient registries<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and clinical practice guidelines began to be developed. The main objective of these tools was to gather more scientific evidence on this disease and offer therapeutic recommendations, given that, thus far, treatment of bronchiectasis, in the best of cases, was extrapolated from that of other airway diseases, such as chronic obstructive pulmonary disease (COPD) or asthma, both of which are conditions on which there is significantly more therapeutic evidence. To a certain extent, this is even the case nowadays. To offer a clear example, even today, more than 70% of patients with bronchiectasis are treated with long-acting bronchodilators, although there is only one published clinical trial (including fewer than 40 patients) that supports their use.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite the above, this scenario has gradually improved over the initial two decades of the 21st century. At present there is a widely accepted definition of bronchiectasis (not due to cystic fibrosis, traction, secondary to pulmonary interstitial processes, nor emphysema), as the abnormal bronchial dilatation resulting from a vicious pathogenic cycle consisting in chronic inflammation and airway repair. This is usually accompanied by an infection by potentially pathogenic microorganisms (PPMs) and characteristic symptoms, such as productive cough, usually with a purulent component, and exacerbations with an infectious profile.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In short, bronchiectasis is considered to be a form of pulmonary involvement of more than a hundred local and systemic diseases capable of causing chronic airway inflammation. Even so, its underlying cause remains unknown in over 25%–35% of cases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A critical point in the clinical evolution of bronchiectasis is the appearance of a bronchial infection caused by PPMs. Infection by <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> (especially its repeated isolation, known as chronic bronchial infection) clearly marks a turning point in the prognosis of patients with bronchiectasis. It is not in vain that the relevant regulations coincide in pointing out that isolations of this microorganism in respiratory samples of patients with bronchiectasis (generally in the sputum), already during a first episode (primary infection), must be forcefully treated with antibiotics. The main goal is to avoid its chronification, especially when it also has a clinical impact on the patient (usually an increase in the number and severity of exacerbations).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8,12,13</span></a> In this sense, excellent studies have been carried out in the context of bronchiectasis (and cystic fibrosis) research, all demonstrating the beneficial effect of certain treatments for this condition (and, in general, for chronic bronchial infection by any PPM causing an accelerated deterioration of the disease). Clear examples of beneficial treatments include macrolides (at immunomodulatory doses and, therefore, with an anti-inflammatory purpose) and inhaled antibiotics, of which there are already several available on the market and which achieve significant pulmonary deposition at the infection site, with few associated systemic adverse effects, thus allowing a prolonged but safe use.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Another key aspect that has advanced in recent years is the determination of the relationship between bronchiectasis and other chronic inflammatory airway diseases, such as COPD or asthma. Several authors agree that between 30% and 50% of patients with severe COPD have bronchiectasis. These areas of bronchiectasis usually have a cylindrical appearance, are viewed in the lung bases, and can only be detected by HRCT. However, their presence has been associated with more severe forms of COPD and a worse prognosis of this disease. In fact, some authors assert that bronchiectasis is part of the natural clinical history of COPD at advanced stages, a presentation that has been termed the COPD-bronchiectasis phenotype. Diagnosing this entity is crucial, as its presence may imply a change in the patient’s therapeutic management. Similarly, up to 25% of patients with severe asthma have bronchiectasis, a presentation that is also associated with a greater number and severity of exacerbations.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This fact allows for appreciating the epidemiological importance of bronchiectasis, which, although clearly underdiagnosed, is already the third most frequent chronic inflammatory airway disease, after COPD and asthma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is also worth noting the recent relationship observed between bronchiectasis and lung infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Some studies agree that bronchiectasis can appear as a pulmonary sequela in up to 30% of cases of pneumonia associated with the 2019 coronavirus disease (COVID-19), and in up to 80% of those of severe pneumonia requiring admission to an intensive care unit (ICU). Although it is assumed that many of these forms of bronchiectasis are a result of traction secondary to pulmonary fibrotic scarring processes, the truth is that their long-term clinical or prognostic impact on the patient is completely unknown and their study represents a great scientific challenge for the near future.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">An important fact that should be considered is that bronchiectasis is a heterogeneous and complex disease,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> therefore, it should not be considered as having exclusively pulmonary involvement, but rather as what has come to be called <span class="elsevierStyleItalic">bronchiectatic syndrome</span>, as the pulmonary inflammation inherent to the disease is often accompanied by systemic inflammation of varying nature.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,18</span></a> Hence, management of patients with this condition should be multidisciplinary, including pulmonologists, internists, radiologists, nutritionists, rehabilitators, physiotherapists, surgeons, microbiologists, or nurses, among others, but also primary care physicians during the clinical suspicion phase and for the management of patients with a chronic ailment. This is because patients with bronchiectasis should not only be treated for their pulmonary infection and inflammation, but also for their underlying etiological disease, potential malnutrition, exacerbations (especially severe ones, which are associated with a worse prognosis of the disease),<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> complications such as hemoptysis or respiratory failure, and, certainly, palliative care in the terminally ill patient. Therefore, it seems advisable that this multidisciplinary team be integrated into specialized units, at least for the management of more complex patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">However, none of the above makes any sense if the health professional assessing these patients does not consider bronchiectasis as a differential diagnosis among all possible airway diseases. A smoker with airflow obstruction should not always be diagnosed with COPD (or with COPD alone) nor should an atopic individual with wheezing always be diagnosed with asthma (or with asthma alone). Because this condition requires specific treatment, an early diagnosis of bronchiectasis is crucial. As mentioned earlier, patients with bronchiectasis, especially those with a bronchial infection or multiple exacerbations, have been shown to benefit more from antiinflammatories, macrolides (at immunomodulatory doses), or antibiotics (especially inhaled) than COPD and asthma patients.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In short, bronchiectasis was never an orphan or banal disease, it simply remained occult until modern diagnostic imaging technology made it an identifiable condition. Despite the wide therapeutic arsenal available today, the number of bronchiectasis diagnoses continues to grow, consequently entailing an increase in healthcare costs. What seems even more paradoxical, both the number of exacerbations and the mortality associated with this disease is increasing, especially among older patients. To conclude, bronchiectasis should not be overlooked, as not all airway conditions can be attributed to COPD or asthma.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors of this paper declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-García MÁ. Bronquiectasias: la enfermedad que nunca fue huérfana. Med Clin (Barc). 2021;157:580–582.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.D. Chalmers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Nat Dis Primers" "fecha" => "2018" "volumen" => "4" "paginaInicial" => "45" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Chandrasekaran" 1 => "M.M. Aogáin" 2 => "J.D. Chalmers" 3 => "J.S. Elborn" 4 => "S.H. Chotirmall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12890-018-0638-0" "Revista" => array:5 [ "tituloSerie" => "BMC Pulm Med" "fecha" => "2018" "volumen" => "18" "paginaInicial" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29788932" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mucosal inflammation in idiopathic bronchiectasis: cellular and molecular mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Fuschillo" 1 => "A. De Felice" 2 => "G. Balzano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Resp J" "fecha" => "2008" "volumen" => "31" "paginaInicial" => "396" "paginaFinal" => "406" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Computed tomography of bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.P. Naidich" 1 => "D.I. McCauley" 2 => "N.F. Khouri" 3 => "F.P. Stitik" 4 => "S.S. Siegelman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00004728-198206000-00001" "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "1982" "volumen" => "6" "paginaInicial" => "437" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7096687" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "RIBRON: The Spanish Online Bronchiectasis Registry. Characterization of the first 1912 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Martinez-García" 1 => "C. Villa" 2 => "Y. Dogarbanes" 3 => "R. Giron" 4 => "L. Maiz" 5 => "M. Garcia-Clemente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2021.01.012" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2021" "volumen" => "57" "paginaInicial" => "28" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34629640" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus document on the diagnosis and treatment of chronic bronchial infection in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => "D. de la Rosa-Carrillo" 1 => "J.L. Lopez-Campos" 2 => "B. Alcazar" 3 => "M. Calle" 4 => "R. Canton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2020.04.023" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2020" "volumen" => "56" "paginaInicial" => "651" "paginaFinal" => "664" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32540279" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish guidelines on treatment of bronchiectasis in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Martinez-Garcia" 1 => "L. Maiz" 2 => "C. Olveira" 3 => "R.M. Giron" 4 => "D. de la Rosa" 5 => "M. Blanco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2017.07.016" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2018" "volumen" => "54" "paginaInicial" => "88" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29128129" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European respiratory society guidelines for the management of adult bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Polverino" 1 => "P.C. Goeminne" 2 => "M.J. McDonnell" 3 => "S. Aliberti" 4 => "S.E. Marshall" 5 => "M. Loebinger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Eur Resp J" "fecha" => "2017" "volumen" => "50" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical efficacy and safety of budesonide-formoterol in non-cystic fibrosis bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Martinez-Garcia" 1 => "J.J. Soler" 2 => "P. Catalan" 3 => "P. Roman" 4 => "M. Perpiña" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "141" "paginaInicial" => "461" "paginaFinal" => "468" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and initial investigation of bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Amati" 1 => "E. Simonetta" 2 => "T. Pilocane" 3 => "A. Gramegna" 4 => "P. Goeminne" 5 => "M. Oriano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0041-1730892" "Revista" => array:6 [ "tituloSerie" => "Semin Respir Crit Care Med" "fecha" => "2021" "volumen" => "42" "paginaInicial" => "513" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34261176" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiology of bronchiectasis in a cohort of 2047 patients. An Analysis of the Spanish Historical Bronchiectasis Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Olveira" 1 => "A. Padilla" 2 => "M.A. Martinez-Garcia" 3 => "D. de la Rosa" 4 => "R.M. Giron" 5 => "M. Vendrell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2016.12.003" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2017" "volumen" => "53" "paginaInicial" => "366" "paginaFinal" => "374" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28118936" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The multiple faces of non-cystic fibrosis bronchiectasis a cluster analysis approach" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Martinez-Garcia" 1 => "M. Vendrell" 2 => "R. Giron" 3 => "L. Maiz" 4 => "D. de la Rosa" 5 => "J. de Gracia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/AnnalsATS.201510-678OC" "Revista" => array:6 [ "tituloSerie" => "Ann Am Thorac Soc" "fecha" => "2016" "volumen" => "13" "paginaInicial" => "1468" "paginaFinal" => "1475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27348199" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "C-Reactive protein concentration in steady-state bronchiectasis: prognostic value of future severe exacerbations. Data from the Spanish Registry of Bronchiectasis (RIBRON)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Posadas" 1 => "G. Oscullo" 2 => "E. Zaldivar" 3 => "C. Villa" 4 => "Y. Dogarbanes" 5 => "R. Giron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2020.12.036" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2021" "volumen" => "57" "paginaInicial" => "21" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34629639" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness and safety of inhaled antibiotics in patients with chronic obstructive pulmonary disease. A multicentre observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => "D. De la Rosa Carrillo" 1 => "M.A. Martinez-Garcia" 2 => "E. Barreiro" 3 => "E. Tabernero" 4 => "R. Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2021.03.009" "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2021" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Polverino" 1 => "K. Dimakou" 2 => "J. Hurst" 3 => "M.A. Martinez-Garcia" 4 => "M. Miravitlles" 5 => "P. Paggiaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01675-2018" "Revista" => array:4 [ "tituloSerie" => "Eur Respir J" "fecha" => "2018" "volumen" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30385603" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchiectasis as a long-term consequence of SARS-COVID-19 pneumonia: Future studies are needed" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Martinez-Garcia" 1 => "T.R. Aksamit" 2 => "S. Aliberti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2021.04.021" "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2021" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dissociation of lung function, dyspnea ratings and pulmonary extension in bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Martinez-Garcia" 1 => "M. Perpina-Tordera" 2 => "J.J. Soler-Cataluna" 3 => "P. Roman" 4 => "A. Lloris" 5 => "A. Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2007.06.028" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2007" "volumen" => "101" "paginaInicial" => "2248" "paginaFinal" => "2253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17698334" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repeteability of circulating eosinophil measures and inhaled corticosteroids effect in bronchiectasis. A post hoc analysis of a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.A. Martinez-Garcia" 1 => "T. Posadas" 2 => "G. Sotgiu" 3 => "F. Blasi" 4 => "L. Saderi" 5 => "S. Aliberti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2020.06.005" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2020" "volumen" => "56" "paginaInicial" => "681" "paginaFinal" => "683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32660708" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The roles of bacteria and viruses in bronchiectasis exacerbation: a prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.L. Chen" 1 => "Y. Huang" 2 => "J.J. Yuan" 3 => "H.M. Li" 4 => "X.R. Han" 5 => "M.A. Martinez-Garcia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbr.2019.12.014" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2020" "volumen" => "56" "paginaInicial" => "621" "paginaFinal" => "629" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33994634" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000012/v1_202112201710/S2387020621006148/v1_202112201710/en/main.assets" "Apartado" => array:4 [ "identificador" => "44147" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000012/v1_202112201710/S2387020621006148/v1_202112201710/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006148?idApp=UINPBA00004N" ]
