Inhaled corticosteroids may be useful in bronchiectasis with peripheral blood eosinophilia

Abstract

Bronchiectasis, a clinical syndrome of recurrent cough and sputum production, can be diagnosed when high-resolution CT (HRCT) scans show pathological airway enlargement. Obstructive airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are diagnosed by the presence of obstructive spirometry with a ratio of forced expiratory volume in 1 s (FEV1) over forced vital capacity (FVC) of <0.7 or the lower limit of normal. People with both obstructive spirometry and HRCT changes are then given the diagnosis of bronchiectasis+asthma overlap or bronchiectasis+COPD overlap. While inhaled corticosteroids (ICS) are the mainstay of treatment for asthma1 and are recommended for use in people with COPD who have frequent exacerbations,2 there is still limited evidence concerning the use of ICS in people with bronchiectasis without asthma or COPD.3 Previous population-based surveys have found that people with bronchiectasis who are prescribed ICS have an increased risk of exacerbations and hospitalisations, with a trend towards increased mortality.4 Thus, the recent European Respiratory Society guidelines for bronchiectasis management recommend against the indiscriminate use of ICS in those with bronchiectasis who do not have asthma or …