Direct assessment of airway microbiota in primary ciliary dyskinesia end-stage lung disease

To the Editor:

Understanding the relationships between chronic bacterial infection, chronic inflammation and progressive lung damage is essential to the effective management of bronchiectasis. Important insight has been gained through analysis of surgically resected specimens of lung tissue from individuals with cystic fibrosis (CF). These studies have variously reported a uniform distribution of a single pathogen in those with end-stage CF lung disease and more diverse and spatially heterogenous microbiota and airway damage in those with less advanced lung disease.

Such findings are consistent with a model of chronic lung disease in which acquisition of highly adaptable and inherently treatment-tolerant airway pathogens, such as Pseudomonas aeruginosa, contributes to increasing airway inflammation and antimicrobial exposure. These exposures, in turn, favour the predominance of pathogens over other airway taxa, promote the emergence of a single species infection and contribute to an acceleration of lung function decline...