Frequent Flares Signal Bronchiectasis Trouble: Marc A. Sala, MD

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Frequent exacerbations are clinical biomarkers underscoring a patient's need for reevaluation, whether that's reassessing medications or ordering more labs and screening. The Chicago Population Health Roundtable, hosted by The American Journal of Managed Care^® (AJMC®), discussed frequent exacerbations as a marker of disease severity that often requires clinicians, specifically those specializing in pulmonology, to reassess the underlying driver and pivot among antimicrobial, anti-inflammatory, immune-directed, and airway-clearance strategies. They also mark opportunities for clinicians to speak with patients, further incentivizing shared decision-making, Marc A. Sala, MD, moderator and associate professor of medicine (pulmonary and critical care) at Northwestern University's Feinberg School of Medicine, said in an interview with AJMC.

"Flares are really thought of as just a biomarker for needing to maybe escalate their care," he said. "But also, a signal that things aren't going well and that you need to be doing due diligence to make sure you have it as best controlled as possible for the current state-of-the-art at least."

Sala emphasized that reevaluation, particularly when treating patients with bronchiectasis, is unlike other diseases where the goals differ in outcomes. For other diseases, clinicians may prioritize early diagnosis and prevention because there are actionable biomarkers that help design a targeted treatment approach. Whereas for bronchiectasis, after diagnosis, all clinicians prioritize slowing or minimizing progression of the disease. However, the introduction of nasal epithelial cells gene expression, among other noninvasive detection methods, could serve as a tool to improve patient outcomes.

"Ideally, when you do those gene-marker-type assessments, you can say, 'Hey, these are the ones that we think are important. They're actually actionable, too. So if we make this one go up or down, that's going to benefit you in the long term, and we can give you hope that you won't really have to worry about this if we're working on it early,'" Sala explained.