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Special Article
Available online 28 September 2022
Pathophysiology of Chronic Bronchial Infection in Bronchiectasis
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Belén Solarata, Lidia Pereaa, Rosa Fanera, David de La Rosab, Miguel Ángel Martínez-Garcíac, Oriol Sibilaa,
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osibila@clinic.cat

Corresponding author.
a Respiratory Department, Hospital Clínic, IDIBAPS, CIBERES, C. de Villaroel, 170, 08036 Barcelona, Spain
b Respiratory Department, Hospital Sant Pau, C. Sant Quintí, 89, 08041 Barcelona, Spain
c Respiratory Department, Hospital La Fe, CIBERES, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
Received 08 September 2022. Accepted 09 September 2022
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Abstract

Bronchiectasis is a complex and heterogeneous disease. Its pathophysiology is poorly understood, but chronic bronchial infection plays an important role in its natural history, and is associated with poor quality of life, more exacerbations and increased mortality. Pseudomonas aeruginosa, Haemophilus influenzae and Staphylococcus aureus are the most common bacteria related to chronic bronchial infection. Non-tuberculous mycobacteria, fungi and respiratory viruses are also present during clinical stability, and may increase the risk of acute exacerbation. Chronic inflammation is present in bronchiectasis, especially neutrophilic inflammation. However, macrophages and eosinophils also play a key role in the disease. Finally, airway epithelium has innate mechanisms such as mucociliary clearance and antibacterial molecules like mucins and antimicrobial peptides that protect the airways from pathogens. This review addresses how the persistence of microorganisms in the airways and the imbalance of the immune system contribute to the development of chronic bronchial infection in bronchiectasis.

Keywords:
Pseudomonas
Neutrophils
Immunity
Fungi
Antimicrobial peptides

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