PDF(Pubmed)
Abstract：
In contrast to significant declines in deaths due to lung cancer and cardiac disease in Westernised countries, the mortality due to \'chronic obstructive pulmonary disease\' (COPD) has minimally changed in recent decades while \'the incidence of bronchiectasis\' is on the rise. The current focus on producing guidelines for these two airway \'diseases\' has hindered progress in both treatment and prevention. The elephant in the room is that neither COPD nor bronchiectasis is a disease but rather a consequence of progressive untreated airway inflammation. To make this case, it is important to review the evolution of our understanding of airway disease and how a pathological appearance (bronchiectasis) and an arbitrary physiological marker of impaired airways (COPD) came to be labelled as \'diseases\'. Valuable insights into the natural history of airway disease can be obtained from the pre-antibiotic era. The dramatic impacts of antibiotics on the prevalence of significant airway disease, especially in childhood and early adult life, have largely been forgotten and will be revisited as will the misinterpretation of trials undertaken in those with chronic (bacterial) bronchitis. In the past decades, paediatricians have observed a progressive increase in what is termed \'persistent bacterial bronchitis\' (PBB). This condition shares all the same characteristics as \'chronic bronchitis\', which is prevalent in young children during the pre-antibiotic era. Additionally, the radiological appearance of bronchiectasis is once again becoming more common in children and, more recently, in adults. Adult physicians remain sceptical about the existence of PBB; however, in one study aimed at assessing the efficacy of antibiotics in adults with persistent symptoms, researchers discovered that the majority of patients exhibiting symptoms of PBB were already on long-term macrolides. In recent decades, there has been a growing recognition of the importance of the respiratory microbiome and an understanding of the ability of bacteria to persist in potentially hostile environments through strategies such as biofilms, intracellular communities, and persister bacteria. This is a challenging field that will likely require new approaches to diagnosis and treatment; however, it needs to be embraced if real progress is to be made.
摘要：
与西方国家因肺癌和心脏病导致的死亡人数大幅下降相反，近几十年来,慢性阻塞性肺疾病(COPD)导致的死亡率变化很小,而支气管扩张症的发病率却在上升.目前对这两种气道疾病指南的关注阻碍了治疗和预防的进展。房间里的大象是，COPD和支气管扩张都不是一种疾病，而是进行性未经治疗的气道炎症的结果。为了做这个案子，重要的是回顾我们对气道疾病的理解的演变,以及气道受损(COPD)的病理表现(支气管扩张)和任意生理标记如何被标记为"疾病".从抗生素前时代可以获得对气道疾病自然史的有价值的见解。抗生素对重大气道疾病患病率的巨大影响，尤其是在童年和成年早期，在很大程度上已被遗忘，并将重新审视对慢性（细菌性）支气管炎患者进行的试验的误解。在过去的几十年里，儿科医生观察到所谓的“持续性细菌性支气管炎”（PBB）逐渐增加。这种情况与“慢性支气管炎”具有相同的特征，这在抗生素前时代的幼儿中很普遍。此外,支气管扩张的放射学外观在儿童中再次变得越来越普遍，最近,在成年人。成年医生仍然对多溴联苯的存在持怀疑态度；然而，在一项旨在评估抗生素在有持续症状的成年人中的疗效的研究中，研究人员发现，大多数表现出PBB症状的患者已经长期服用大环内酯类药物。近几十年来,人们越来越认识到呼吸道微生物组的重要性，并通过生物膜等策略了解细菌在潜在的恶劣环境中持续存在的能力，细胞内群落，和持久细菌。这是一个具有挑战性的领域，可能需要新的诊断和治疗方法;然而，如果要取得真正的进展，就需要接受它。
