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Review
. 2024 Sep 30:15:20420986241279213.
doi: 10.1177/20420986241279213. eCollection 2024.

Safety profile of drugs used in non-cystic fibrosis bronchiectasis: a narrative review

Henil Upadhyay  1 , Stefano Aliberti  2 , Andrew Husband  3 , James D Chalmers  4 , Katy Hester  5 , Anthony De Soyza  6
Affiliations
Review

Safety profile of drugs used in non-cystic fibrosis bronchiectasis: a narrative review

Henil Upadhyay et al. Ther Adv Drug Saf. .

Abstract

Non-cystic fibrosis bronchiectasis is a long-term lung disease characterised by abnormal dilatation of the bronchi, with patients experiencing chronic productive cough and recurrent exacerbations. Currently, there are no licensed drugs for use in bronchiectasis while clinical trials have been conducted to either test new drugs or repurpose existing ones. These drugs target the underlying pathophysiology of bronchiectasis which is known to include infection, inflammation, mucus hypersecretion and retention. Most of the drugs used in daily clinical practice for bronchiectasis are off-label with no randomised trials exploring their safety. This review aims at exploring the safety profile of drugs frequently used in clinical practice to manage bronchiectasis, including antibiotics (e.g. macrolides, aminoglycosides, polymyxins, fluoroquinolones, aztreonam), mucoactive therapy (e.g. hypertonic saline, mannitol, DNase and carbocisteine), anti-inflammatory therapy (inhaled corticosteroids) and drugs currently in development for use in bronchiectasis (e.g. brensocatib, benralizumab and itepekimab).

Keywords: bronchiectasis; multimorbidity; novel drug therapy; polypharmacy; repurposed drugs; safety profile.

Plain language summary

A review on the safety aspects of drugs currently being used in bronchiectasis This review aims to detail the safety aspects of drugs that are currently prescribed to patients with bronchiectasis. These drugs are used in bronchiectasis without some of the high quality trials seen for other lung conditions. The drugs used have shown clinical benefits in patients who are suffering from infective exacerbations or worsening of the disease. The idea behind the use of these drugs is that they target the pathological processes in bronchiectasis such as inflammation, infection and excess mucus production. In this review, we have included the results from clinical trials that assessed the use of antibiotics (both oral and inhaled) during pulmonary infections and long-term antibiotics to prevent infections. Mucus production is a major symptom of bronchiectasis, and hence the drugs that target mucus secretion and consistency are used in an attempt to improve the quality of life and prevent infections. Inflammation is a key component of bronchiectasis, and we report on the safety of inhaled steroids in bronchiectasis. Some new drugs are currently being tried in clinical trials worldwide and are discussed. The occurrence of multiple other medical problems are recognized in people living with bronchiectasis has been seen to increase symptoms and linked with higher infection rates and hospitalizations. This means patients are often on lots of different medications for multiple conditions; we highlight the importance of considering the fact these drugs in combination can lead to potential issues and side effects linked to polypharmacy.

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References

    1. Aliberti S, Goeminne PC, O’Donnell AE, et al.. Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: international consensus recommendations. Lancet Respir Med 2022; 10: 298–306. - PubMed
    1. Imam JS, Duarte AG. Non-CF bronchiectasis: orphan disease no longer. Respir Med 2020; 166: 105940. - PubMed
    1. Polverino E, Cacheris W, Spencer C, et al.. Global burden of non-cystic fibrosis bronchiectasis: a simple epidemiological analysis. Eur Respir J 2012; 40: P3983.
    1. Chalmers JD, Polverino E, Crichton ML, et al.. Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis Registry (EMBARC). Lancet Respir Med 2023; 11: 637–649. - PubMed
    1. Polverino E, Goeminne PC, McDonnell MJ, et al.. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017; 50: 1700629. - PubMed

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