Aspiration and GERD in Bronchiectasis: Bridging Pulmonology, Gastroenterology, and Otolaryngology in an At-Risk Population.

Abstract

Bronchiectasis is a heterogeneous chronic lung disease marked by irreversible airway dilation and damage, instigating symptoms of chronic cough, dyspnea, and excessive mucus production. Recurrent exacerbations or infections with ongoing inflammation can lead to impaired quality of life, reduced ability to clear mucus, and even respiratory failure. Dozens of distinct conditions can contribute or coexist with bronchiectasis, often fueling a self-perpetuating vortex of inflammation, infection, and airway remodeling. Aspiration results in foreign particles into the airway can cause chemical pneumonitis from gastric contents, airway inflammation, and/or infection, with repeated exposures producing chronic injury. As clinical expertise has grown, aspiration-related pathology has acquired attention as a potential contributor to bronchiectasis and chronic lung infections, including nontuberculous mycobacteria (NTM), extrapolating from characterized relationships in other chronic lung diseases. Nonspecific symptoms, diagnostic challenges, and incomplete data characterizing the relationship have hindered the development of clear guidelines. Additionally, the necessity for multidisciplinary care can delay timely management. Here, we assembled a multidisciplinary team of experts to evaluate retrograde and anterograde aspiration as modifiable comorbidities to bronchiectasis through case-based formatting. Using this scaffold and a narrative literature review, we provide clinical perspective on who, when, and how to test for aspiration from swallowing dysfunction and reflux disease. Our purpose is to raise awareness of aspiration, enhance evaluation by improving the pulmonologist's knowledge of test selection and interpretation, highlight the value of cross-disciplinary discussion, outline basic management strategies, and inspire further studies within bronchiectasis and chronic lung infection populations.