Are viral infections worsening bronchiectasis symptoms?

23 October 2023

A new research study aims to determine the role and impact of viruses in individuals with bronchiectasis.

Bronchiectasis is a long-term lung condition where the airways of the lungs become widened, leading to a build-up of excess mucus. This excess mucus can make the lungs more vulnerable to infection.

The most common symptoms of bronchiectasis include a persistent cough (that usually brings up phlegm) and shortness of breath.

Individuals with bronchiectasis are susceptible to a worsening of their symptoms, known as exacerbations. These exacerbations are a major cause of morbidity and mortality and there are currently very limited treatment options.

Bacteria versus viruses

Previously, it was thought that exacerbations were caused by bacteria, however, recently researchers have found that approximately 40% of exacerbations are linked to viruses, which may be an unrecognised trigger for bronchiectasis exacerbations.

This was highlighted during the COVID-19 pandemic when there was a considerable reduction in bronchiectasis exacerbation rates, which may be due to reduced social interactions between individuals, limiting exposure to circulating viruses.

However, it remains unclear whether viruses can directly trigger exacerbations in bronchiectasis and what the mechanisms are which make individuals more susceptible to viral infections.

The research

Dr Aran Singanayagam and Dr Anand Shah, respiratory consultants at Royal Brompton and Harefield hospitals, aim to answer some of these questions by conducting a rhinovirus infection study.

This will involve introducing the rhinovirus (common cold) into the nose of individuals with bronchiectasis and healthy volunteers, to induce infection. This is known as the human viral challenge model.

The research team will look at respiratory symptoms and lung function to determine if there is a difference in flare-up of symptoms between the two groups.

They will also look at samples from the nose, mucus (phlegm) and the lungs, to measure how the immune system is working against the virus, the role and impact of resident bacterial communities and whether this leads to impaired antiviral immunity in individuals with bronchiectasis.

On receiving the funding, Dr Shah said:

“This funding will provide a unique opportunity to develop a first-in-kind human challenge model of exacerbations for individuals with bronchiectasis. To date, there are no licensed therapies in bronchiectasis and research is hampered by a lack of appropriate model systems to understand susceptibility to exacerbations, which are critical to outcome”.

Dr Singanayagam was also pleased with the funding and said:

“We anticipate, through this study, we will understand the critical drivers of susceptibility to exacerbation and also develop a model that can be used to test current and future novel therapies.”

The research is funded by the Medical Research Council, and will be conducted in collaboration with Imperial College London, the University of Dundee, the University of Southampton and Nanyang Technological University in Singapore.

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