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Reflux in Bronchiectasis - project introduction

I will examine the role of ‘extra-oesophageal reflux and aspiration’ (backflow of stomach contents, with some entering into the lung) as a contributing factor in the development and severity of a common, chronic lung condition called bronchiectasis. We believe that reflux of stomach contents, with movement into the lung, stimulates an injury response that leads to progressive inflammation and damage to the airways. To study this theory, I will examine the association of reflux in patients with bronchiectasis compared to those without, comparing these levels to disease severity.

What is the project?

We will collect washings of the airways during camera based examinations to allow further investigations on the lung cells cultured in a laboratory. We will stimulate these cells using varying amounts of reflux components and measure the associated inflammatory effect.

We will also investigate a specific new treatment called azithromycin to see if it affects inflammation caused by reflux. By comparing the amount of reflux and related immune response across a range of bronchiectasis patients compared with controls, we will find out how important this pathway is for preventing or slowing the development and progression of this disease.

What impact does bronchiectasis have on patients?

Patients often suffer from frequent, severe chest infections that can significantly impact their ability to perform daily activities and reduce their quality of life.

In bronchiectasis, the airways become abnormally inflamed and dilated. This causes extra mucus to form and pool in the airways. The extra mucus is difficult to clear and makes the airways prone to infections, ultimately creating a vicious cycle of recurrent chest infections and progressive lung damage. The lung tissue next to a badly inflamed section of airway may also become inflamed and damaged. The severity of symptoms depends on how much of the lung is damaged and how bad the damage is.

Why is this research important?

Current treatment is aimed at relieving symptoms only. There are a number of known causes of this condition. It commonly occurs as a consequence of other disease processes. However, in approximately 50% of cases, the cause is unknown despite thorough investigation. There is no available treatment to slow the progression of disease.

What are the implications of your project for treatment or clinical practice?

This research has direct relevance for a clinical condition that imposes a significant burden worldwide. A better understanding of the natural history of bronchiectasis would be of great value, both in allowing more accurate prognostic information and in determining specific characteristics of the disease that lead to increased severity.

This project shows great potential in determining the relevance of azithromycin in treating reflux-induced bronchiectasis and should produce valuable data to better inform current practice. This project may influence practical guidelines for the treatment of bronchiectasis and form the basis of ideas for clinical trials and multi-centre collaborations in this clinical area.