State-of-the-Art Session: Respiratory Infections

In recent decades, there has been growing interest in the recognition and management of both bronchiectasis and nontuberculous mycobacteria (NTM) pulmonary disease. More specifically, interest in diagnosing NTM infection in patients with bronchiectasis has dramatically increased. Publication of the European Respiratory Society (ERS) guidelines and results from a number of large clinical trials have resulted in an exciting year for bronchiectasis research. Despite the increased knowledge and expanding options for disease management, a number of challenges persist. There remains a paucity of evidence to support management recommendations, which have not kept pace with the growing attention given to these diseases. To explore these limitations, Prof Chalmers summarised the reasoning behind the new guidelines. The main objectives of these two presentations were to provide an expert overview of the challenges and achievements in the management of bronchiectasis and NTM pulmonary diseases, as well as predicting future trends. Dr van Ingen called for caution when managing these diseases because neither bronchiectasis nor NTM pulmonary disease can be described as single disease entities and, therefore, cannot be treated as such. The presence of NTM pulmonary disease is often a sign of multiple underlying conditions that must be addressed in tandem with culture conversion. Likewise, bronchiectasis pathogenesis is complex and failure of antibiotic therapy to offer consistent clinical benefit suggests infection is not central to pathogenesis in all patients, and a holistic approach is required. Finally, these interactive sessions uncovered and discussed various aspects and attitudes associated with disease management and highlighted how quality of care may be closely linked to clinical outcomes.