what is narrative literature review

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What is a Narrative Literature Review

Narrative review process.

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A narrative literature review is an integrated analysis of the existing literature used to summarize a body of literature, draw conclusions about a topic, and identify research gaps. By understanding the current state of the literature, you can show how new research fits into the larger research landscape.

A narrative literature review is NOT:

Just a summary of sources
A review of everything written on a particular topic
A research paper arguing for a specific viewpoint - a lit review should avoid bias and highlight areas of disagreements
A systematic review

Purposes of a narrative literature review:

Explain the background of research on a topic
Demonstrate the importance of a topic
Suggest new areas of research
Identify major themes, concepts, and researchers in a topic
Identify critical gaps, points of disagreement, or flawed approaches for a research topic

1. Choose a topic & create a research question

Use a narrow research question for more focused search results
Use a question framework such as PICO to develop your research question
Breakdown your research question into searchable concepts and keywords
Research skills tutorials : How to choose a topic
Ask a librarian for assistance

2. Select the sources for searching & develop a search strategy

Identify databases to search for articles relevant to your topic
Ask a librarian for recommended databases
Develop a comprehensive search strategy using keywords, controlled vocabularies and Boolean operators
Research skills tutorials: How to develop a search strategy

3. Conduct the search

Use a consistent search strategy between databases
Document the strategies employed to keep track of which are more successful
Use a citation manager to organize your search results
Ask a librarian for help or refer to the Research skills tutorials

4. Review the references

Review the search results for relevant articles that answer your research question
Review the bibliography of all relevant articles for additional sources
Consider developing subfolders in the citation manager to organize sources by topic
Use interlibrary loan for any articles without full text access

5. Summarize findings

Synthesize the findings from the articles into a final paper
The final paper should cover the themes identified in the research, explain any conflicts or disagreements, identify research gaps and potential future research areas, explain how this narrative review fits within the existing research and answer the research question .

For additional information :

Hempel. (2020). Conducting your literature review. American Psychological Association .

Buchholz, & Dickins, K. A. (2023). Literature review and synthesis : a guide for nurses and other healthcare professionals . Springer Publishing Company, LLC.
Coughlan, Michael, and Patricia Cronin. Doing a Literature Review in Nursing, Health and Social Care . 2nd edition., SAGE, 2017.
Nundy, S., Kakar, A., Bhutta, Z.A. (2022). How to Do a Review of the Literature? . In: How to Practice Academic Medicine and Publish from Developing Countries?. Springer, Singapore. https://doi.org/10.1007/978-981-16-5248-6_18
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Literature Review: Traditional or narrative literature reviews

Traditional or narrative literature reviews.

Scoping Reviews
Systematic literature reviews
Annotated bibliography
Keeping up to date with literature
Finding a thesis
Evaluating sources and critical appraisal of literature
Managing and analysing your literature
Further reading and resources

A narrative or traditional literature review is a comprehensive, critical and objective analysis of the current knowledge on a topic. They are an essential part of the research process and help to establish a theoretical framework and focus or context for your research. A literature review will help you to identify patterns and trends in the literature so that you can identify gaps or inconsistencies in a body of knowledge. This should lead you to a sufficiently focused research question that justifies your research.

Onwuegbuzie and Frels (pp 24-25, 2016) define four common types of narrative reviews:

General literature review that provides a review of the most important and critical aspects of the current knowledge of the topic. This general literature review forms the introduction to a thesis or dissertation and must be defined by the research objective, underlying hypothesis or problem or the reviewer's argumentative thesis.
Theoretical literature review which examines how theory shapes or frames research
Methodological literature review where the research methods and design are described. These methodological reviews outline the strengths and weaknesses of the methods used and provide future direction
Historical literature review which focus on examining research throughout a period of time, often starting with the first time an issue, concept, theory, phenomena emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and to identify the likely directions for future research.

References and additional resources

Baker, J. D. (2016) The purpose, process and methods of writing a literature review: Editorial . Association of Operating Room Nurses. AORN Journal, 103 (3), 265-269. doi:10.1016/j.aorn.2016.01.016

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The Literature Review

Narrative Review
Systematic Review
Scoping Review

Writing your Literature Review

Once you have developed a body of literature to draw from, you can begin writing your literature review. There is no set format for a narrative literature review, and it can vary across fields. However, you will typically see the following elements:

Sections you might see in a typical research paper including Introduction, background, (possibly) methods, Main/Body, and Conclusion
Some logical structure of sections (i.e. by time period, by areas of the field, by approach of article etc.)
Analysis of the relative value of contributions across different sources
section on areas for further development or further research suggestions

Need writing help? Head to the Graduate Writing Center for help with your literature review!

What is a narrative literature review.

Narrative Literature Reviews are works in which the author reviews a body of literature on a topic and synthesizes the information into a clear narrative that demonstrates the general context of the field . They can also be called a Traditional Literature Review. Compared to Systematic and Scoping reviews, Narrative literature reviews do not use an established method or protocol, but rather take a broad, unspecified approach to what sources are selected to represent the field. Typically narrative literature reviews use peer-reviewed journal articles as their source of scholarship to review, but this might vary based on the individual assignment or review you are conducting. Below are some key elements of a Narrative Lit Review:

Places the topic within an existing context
Describes relationships between and around sources cited
Typically includes critical analysis
Organizes ideas by theme and/or relevance
Demonstrates author's knowledge

Staying Organized

Use a reference management software.

Reference Managers are tools that can help you keep track of the scholarly articles you are collecting and reading for your literature review. They can also help you generate citations and bibliographies within your writing. Use the Reference Management Software Guide linked below to learn more about how to get started with one.

Reference Management Research Guide

Keep your search terms in a document or spreadsheet.

Although in Narrative Lit Reviews you are not required to keep detailed reports on your search strategy, it is still important to keep track of the terms you are searching and include information about them to be sure you are casting the widest net possible. Organize your search terms in a way that makes sense to you. As an example, you could keep tabs on:

Broader terms
Narrower terms
Filters that work / filters that don't
Search strings you can copy and paste directly into search engines and databases

The Research Process

Start with an exploratory/preliminary search.

Use a couple key terms about your topic to try searching without keeping track to see whats out there. This is also a good time to search for already existing reviews on your topic and see if something similar has already been completed. After doing a preliminary search in your general topic, you can begin thinking about your specific research question.

Drafting a Research Question

To start drafting your research question, it may be helpful to consider how your topic fits within a couple of different broad overlapping fields of research. For example, the research question illustrated below asks about identity perspectives from Asian American students in high schools. Each individual topic in this question is its own circle, and the intersection of these circles is the main focus of the literature review. There could be more circles added for each new dimension I would like to add to my research question whether it be a location (i.e. New York City), a clarifying detail (i.e. generational identity), or other form of context.

As you are searching, use the different dimensions of your research question to find individual areas of research, For example, I may want to look at the literature around just the identity of Asian American students, or maybe just look at identity formation in High School. Then, in my literature review, I can synthesize these various fields to explain the different backgrounds and how they all converge around my central topic, the middle of the diagram.

Image from Tips and Strategies for Writing a Dissertation Proposal on Ashe Grads blog.

Conducting your Search

Once you have your research question and key terms from that research question, you can start your formal searching process. In narrative literature reviews it is less important to be comprehensive in checking every possibly relevant result, but more focused on making sure the results you are getting are representative of the fields you are analyzing.

Books in the Libraries to Help with you Narrative Lit Review

Literature Review and Research Design: A Guide to Effective Research Practice

They Say / I Say: The Moves That Matter in Academic Writing, with Readings

The Literature Review: Six Steps to Success

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Research Guides

Planning For Your Expert Literature Review

Narrative literature reviews.

Types of Expert Literature Reviews

Your Narrative Literature Review Should Have...

A clearly defined topic
A search for relevant literature
A logical organization structure
An interpretation and discussion of the selected relevant literature

A common structure for narrative literature reviews is IMRaD, or:

Introduction
What is your topic?
What are you interested in finding out?
Why did you select this topic?
How did you look for the literature?
Where did you look?
What search terms did you use?
What kind of literature did you find?
Did the literature you found change your opinion on the topic?
Did you find out something new?
What were the key concepts?
and Discussion
Evaluate and summarize the major concepts
Connect the major concepts to future research potential

While the structure above may be sufficient for your topic, you may also consider using the similar but more robust structure IAMRDC, or:

Ferrari, R. (2015). Writing narrative style literature reviews. Medical Writing, 24 (4), 230-235. https://doi.org/10.1179/2047480615Z.000000000329
Sollaci, L. B., & Pereira, M. G. (2004). The introduction, methods, results, and discussion (IMRAD) structure: a fifty-year survey. Journal of the Medical Library Association 92 (3), 364–367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC442179/

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UConn Library
Literature Review: The What, Why and How-to Guide
Introduction

Literature Review: The What, Why and How-to Guide — Introduction

Getting Started
How to Pick a Topic
Strategies to Find Sources
Evaluating Sources & Lit. Reviews
Tips for Writing Literature Reviews
Writing Literature Review: Useful Sites
Citation Resources
Other Academic Writings

What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D. The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review? A literature could be written to accomplish different aims:

To develop a theory or evaluate an existing theory
To summarize the historical or existing state of a research topic
Identify a problem in a field of research

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews . Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

A research paper assigned in a course
A thesis or dissertation
A grant proposal
An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework: 10.1177/08948453211037398

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

Example : The effect of leave policies on increasing fertility: a systematic review: 10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

Example : Employment Instability and Fertility in Europe: A Meta-Analysis: 10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts . Journal of Advanced Nursing , 53 (3), 311-318.

Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis: 10.1177/05390184221113735

Literature Reviews in the Health Sciences

UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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v.8(11); 2016 Nov

How to Conduct a Systematic Review: A Narrative Literature Review

Nusrat jahan.

1 Psychiatry, Mount Sinai Chicago

Sadiq Naveed

2 Psychiatry, KVC Prairie Ridge Hospital

Muhammad Zeshan

3 Department of Psychiatry, Bronx Lebanon Hospital Icahn School of Medicine at Mount Sinai, Bronx, NY

Muhammad A Tahir

4 Psychiatry, Suny Upstate Medical University, Syracuse, NY

Systematic reviews are ranked very high in research and are considered the most valid form of medical evidence. They provide a complete summary of the current literature relevant to a research question and can be of immense use to medical professionals. Our goal with this paper is to conduct a narrative review of the literature about systematic reviews and outline the essential elements of a systematic review along with the limitations of such a review.

Introduction and background

A literature review provides an important insight into a particular scholarly topic. It compiles published research on a topic, surveys different sources of research, and critically examines these sources [ 1 ]. A literature review may be argumentative, integrative, historical, methodological, systematic, or theoretical, and these approaches may be adopted depending upon the types of analysis in a particular study [ 2 ].

Our topic of interest in this article is to understand the different steps of conducting a systematic review. Systematic reviews, according to Wright, et al., are defined as a “review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and analyze data from the studies that are included in the review” [ 3 ]. A systematic review provides an unbiased assessment of these studies [ 4 ]. Such reviews emerged in the 1970s in the field of social sciences. Systematic reviews, as well as the meta-analyses of the appropriate studies, can be the best form of evidence available to clinicians [ 3 ]. The unsystematic narrative review is more likely to include only research selected by the authors, which introduces bias and, therefore, frequently lags behind and contradicts the available evidence [ 5 ].

Epidemiologist Archie Cochrane played a vital role in formulating the methodology of the systematic review [ 6 ]. Dr. Cochrane loved to study patterns of disease and how these related to the environment. In the early 1970s, he found that many decisions in health care were made without reliable, up-to-date evidence about the treatments used [ 6 ].

A systematic review may or may not include meta-analysis, depending on whether results from different studies can be combined to provide a meaningful conclusion. David Sackett defined meta-analysis as a “specific statistical strategy for assembling the results of several studies into a single estimate” [ 7 - 8 ].

While the systematic review has several advantages, it has several limitations which can affect the conclusion. Inadequate literature searches and heterogeneous studies can lead to false conclusions. Similarly, the quality of assessment is an important step in systematic reviews, and it can lead to adverse consequences if not done properly.

The purpose of this article is to understand the important steps involved in conducting a systematic review of all kinds of clinical studies. We conducted a narrative review of the literature about systematic reviews with a special focus on articles that discuss conducting reviews of randomized controlled trials. We discuss key guidelines and important terminologies and present the advantages and limitations of systematic reviews.

Narrative reviews are a discussion of important topics on a theoretical point of view, and they are considered an important educational tool in continuing medical education [ 9 ]. Narrative reviews take a less formal approach than systematic reviews in that narrative reviews do not require the presentation of the more rigorous aspects characteristic of a systematic review such as reporting methodology, search terms, databases used, and inclusion and exclusion criteria [ 9 ]. With this in mind, our narrative review will give a detailed explanation of the important steps of a systematic review.

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) checklist

Systematic reviews are conducted based on predefined criteria and protocol. The PRISMA-P checklist, developed by Moher, et al., contains 17 items (26 including sub-items) comprising the important steps of a systematic review, including information about authors, co-authors, their mailing and email addresses, affiliations, and any new or updated version of a previous systematic review [ 9 ]. It also identifies a plan for documenting important protocol amendments, registry names, registration numbers, financial disclosures, and other support services [ 10 ]. Moher, et al. also state that methods of systematic reviews involve developing eligibility criteria and describing information sources, search strategies, study selection processes, outcomes, assessment of bias in individual studies, and data synthesis [ 10 ].

Research question

Writing a research question is the first step in conducting a systematic review and is of paramount importance as it outlines both the need and validity of systematic reviews (Nguyen, et al., unpublished data). It also increases the efficiency of the review by limiting the time and cost of identifying and obtaining relevant literature [ 11 ]. The research question should summarize the main objective of a systematic review.

An example research question might read, “How does attention-deficit/hyperactivity disorder (ADHD) affect the academic performance of middle school children in North America?” The question focuses on the type of data, analysis, and topic to be discussed (i.e., ADHD among North American middle school students). Try to avoid research questions that are too narrow or broad—they can lead to the selection of only a few studies and the ability to generalize results to any other populations may be limited. An example of a research question that is too narrow would be, “What is the prevalence of ADHD in children and adolescents in Chicago, IL?” Alternately, if the research question is too broad, it can be difficult to reach a conclusion due to poor methodology. An example of a research question that is too broad in scope would be, “What are the effects of ADHD on the functioning of children and adolescents in North America?”

Different tools that can be used to help devise a research question, depending on the type of question, are: population, intervention, comparator, and outcomes (PICO); sample, phenomenon of interest, design, evaluation, and research type (SPIDER); setting, perspective, intervention, comparison, and evaluation (SPICE); and expectation, client group, location, impact, professionals, and service (ECLIPSE).

The PICO approach is mostly used to compare different interventions with each other. It helps to formulate a research question related to prognosis, diagnosis, and therapies [ 12 ].

Scenario: A 50-year-old white woman visited her psychiatrist with a diagnosis of major depressive disorder. She was prescribed fluoxetine, which she feels has been helpful. However, she experienced some unpleasant side effects of nausea and abdominal discomfort. She has recently been told by a friend about the use of St. John’s wort in treating depression and would like to try this in treating her current depression. (Formulating research questions, unpublished data).

In the above-mentioned scenario, the sample population is a 50-year-old female with major depressive disorder; the intervention is St. John’s wort; the comparison is fluoxetine; and the outcome would be efficacy and safety. In order to see the outcome of both efficacy and safety, we will compare the efficacy and safety of both St. John’s wort and fluoxetine in a sample population for treating depression. This scenario represents an example where we can apply the PICO approach to compare two interventions.

In contrast, the SPIDER approach is focused more on study design and samples rather than populations [ 13 ]. The SPIDER approach can be used in this research question: “What is the experience of psychiatry residents attending a transgender education?” The sample is psychiatry residents; the phenomenon of interest is transgender education; the design is a survey; the evaluation looks at the experience; and the research type is qualitative.

The SPICE approach can be used to evaluate the outcome of a service, intervention, or project [ 14 ]. The SPICE approach applies to the following research question: “In psychiatry clinics, does the combined use of selective serotonin reuptake inhibitor (SSRI) and psychotherapy reduce depression in an outpatient clinic versus SSRI therapy alone?” The setting is the psychiatry clinic; the perspective/population is the outpatient; the intervention is combined psychotherapy and SSRI; the comparison is SSRI alone; and the evaluation is reduced depression.

The ECLIPSE approach is useful for evaluating the outcome of a policy or service (Nguyen, et al., unpublished data). ECLIPSE can apply in the following research question: “How can a resident get access to medical records of patients admitted to inpatient from other hospitals?” The expectation is: “What are you looking to improve/change to increase access to medical records for patients admitted to inpatient?” The client group is the residents; the location is the inpatient setting; the impact would be the residents having easy access to medical records from other hospitals; and the professionals in this scenario would be those involved in improving the service experiences such as hospital administrators and IT staff.

Inclusion and exclusion criteria

Establishing inclusion and exclusion criteria come after formulating research questions. The concept of inclusion and exclusion of data in a systematic review provides a basis on which the reviewer draws valid and reliable conclusions regarding the effect of the intervention for the disorder under consideration [ 11 ]. Inclusions and exclusion are based on preset criteria for specific systematic review. It should be done before starting the literature search in order to minimize the possibility of bias.

Eligibility criteria provide the boundaries of the systematic review [ 15 ]. Participants, interventions, and comparison of a research question provide the basis for eligibility criteria [ 15 ]. The inclusion criteria should be able to identify the studies of interest and, if the inclusion criteria are too broad or too narrow, it can lead to an ineffective screening process.

Protocol registration

Developing and registering research protocol is another important step of conducting a systematic review. The research protocol ensures that a systematic review is carefully planned and explicitly documented before the review starts, thus promoting consistency in conduct for the review team and supporting the accountability, research integrity, and transparency of the eventually completed review [ 10 ]. PROSPERO and the Cochrane Database of Systematic Reviews are utilized for registering research protocols and research questions, and they check for prior existing duplicate protocols or research questions. PROSPERO is an international database of prospectively registered systematic reviews related to health care and social sciences (PRISMA, 2016). It is funded by the National Institute for Health Research. The Cochrane Collaboration concentrates on producing systematic reviews of interventions and diagnostic test accuracy but does not currently produce reviews on questions of prognosis or etiology [ 16 ].

A detailed and extensive search strategy is important for the systematic review since it minimizes bias in the review process [ 17 ].

Selecting and searching appropriate electronic databases is determined by the topic of interest. Important databases are: MEDLARS Online (MEDLINE), which is the online counterpart to the Medical Literature Analysis and Retrieval System (MEDLARS); Excerpta Medica Database (EMBASE); and Google Scholar. There are multiple electronic databases available based on the area of interest. Other important databases include: PsycINFO for psychology and psychiatry; Allied and Complementary Medicine Database (AMED) for complementary medicine; Manual, Alternative, and Natural Therapy Index System (MANTIS) for alternative medical literature; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for nursing and allied health [ 15 ].

Additional studies relevant for the review may be found by looking at the references of studies identified by different databases [ 15 ]. Non-indexed articles may be found by searching the content of journals, conferences proceedings, and abstracts. It will also help with letters and commentaries which may not get indexed [ 15 ]. Reviewing clinical trial registries can provide information about any ongoing trials or unpublished research [ 15 ]. A gray literature search can access unpublished papers, reports, and conference reports, and it generally covers studies that are published in an informal fashion, rather than in an indexed journal [ 15 ]. Further search can be performed by selecting important key articles and going through in-text citations [ 15 ].

Using Boolean operators, truncation, and wildcards

Boolean operators use the relationship between different search words to help with the search strategy. These are simple words (i.e., AND, OR, and NOT) which can help with more focused and productive results (poster, Jahan, et al.: How to conduct a systematic review. APPNA 39th Summer Convention. Washington, DC. 2016). The Boolean operator AND finds articles with all the search words. The use of OR broadens the focus of the search, and it will include articles with at least one search term. The researchers can also ignore certain results from the records by using NOT in the search strategy.

An example of AND would be using “depression” AND “children” in the search strategy with the goal of studying depression in children. This search strategy will include all the articles about both depression and children. The researchers may use OR if the emphasis of the study is mood disorders or affective disorders in adolescents. In that case, the search strategy will be “mood disorders” OR “affective disorders” AND “adolescents.” This search will find all the articles about mood disorders or affective disorders in adolescents. The researchers can use NOT if they only want to study depression in children and want to ignore bipolar disorder from the search. An example search in this scenario would be “depression” NOT “bipolar disorder” AND “children.” This will help ignore studies related to bipolar disorder in children.

Truncation and wildcards are other tools to make search strategy more comprehensive and focused. While the researchers search a database for certain articles, they frequently face terminologies that have the same initial root of a word but different endings. An example would be "autism," "autistic," and "autism spectrum disorder." These words have a similar initial root derived from “autis” but they end differently in each case. The truncation symbol (*) retrieves articles that contain words beginning with “autis” plus any additional characters. Wildcards are used for words with the same meanings but different spellings due to various reasons. For the words with spelling variations of a single letter, wildcard symbols can be used. When the researcher inputs “M+N” in the search bar, this returns results containing both “man” or “men” as the wildcard accounts for the spelling variations between the letters M and N.

Study selection

Study selection should be performed in a systematic manner, so reviewers deal with fewer errors and a lower risk of bias (online course, Li T, Dickersin K: Introduction to systematic review and meta-analysis. 2016. https://www.coursera.org/learn/systematic-review #). Study selection should involve two independent reviewers who select studies using inclusion and exclusion criteria. Any disagreements during this process should be resolved by discussion or by a third reviewer [ 10 ]. Specific study types can be selected depending on the research question. For example, questions on incidence and prevalence can be answered by surveys and cohort studies. Clinical trials can provide answers to questions related to therapy and screening. Queries regarding diagnostic accuracy can be answered by clinical trials and cross-sectional studies (online course, Li T, Dickersin K: Introduction to systematic review and meta-analysis. 2016. https://www.coursera.org/learn/systematic-review #). Prognosis and harm-related questions should use cohort studies and clinical trials, and etiology questions should use case-control and cohort studies (online course, Li T, Dickersin K: Introduction to systematic review and meta-analysis. 2016. https://www.coursera.org/learn/systematic-review #).

Data screening and data extractions are two of the major steps in conducting a systematic review [ 18 ]. Data screening involves searching for relevant articles in different databases using keywords. The next step of data screening is manuscript selection by reviewing each manuscript in the search results to compare that manuscript against the inclusion criteria [ 18 ]. The researchers should also review the references of the papers selected before selecting the final paper, which is the last step of data screening [ 18 ].

The next stage is extracting and appraising the data of the included articles [ 18 ]. A data extraction form should be used to help reduce the number of errors, and more than one person should record the data [ 17 ]. Data should be collected on specific points like population type, study authors, agency, study design, humanitarian crisis, target age groups, research strengths from the literature, setting, study country, type(s) of public health intervention, and health outcome(s) addressed by the public health intervention. All this information should then be put into an electronic database [ 18 ].

Assessing bias

Bias is a systematic error (or deviation from the truth) in results or inferences. Biases can change the results of any study and lead to an underestimation or overestimation of the true intervention effect [ 19 ]. Biases can impact any aspect of a review, including selecting studies, collecting and extracting data, and making a conclusion. Biases can vary in magnitude; some are small, with negligible effect, but some are substantial to a degree where an apparent finding may be entirely due to bias [ 19 ]. There are different types of bias, including, but not limited to, selection, detection, attrition, reporting, and performance.

Selection bias occurs when a sample selected is not representative of the whole general population. If randomization of the sample is done correctly, then chances of selection bias can be minimized [ 20 ].

Detection bias refers to systematic differences between groups in how outcomes are determined. This type of bias is based on knowledge of the intervention provided and its outcome [ 19 ].

Attrition bias refers to systematic differences between groups in withdrawals from a study [ 19 ]. The data will be considered incomplete if some subjects are withdrawn or have irregular visits during data collection.

Reporting bias refers to systematic differences between reported and unreported findings, and it is commonly seen during article reviews. Reporting bias is based on reviewer judgment about the outcome of selected articles [ 20 ].

Performance bias develops due to the knowledge of the allocated interventions by participants and personnel during the study [ 20 ]. Using a double-blind study design helps prevent performance bias, where neither the experimenter nor the subjects know which group contains controls and which group contains the test article [ 14 ].

Last step of systematic review: discussion

The discussion of a systematic review is where a summary of the available evidence for different outcomes is written and discussed [ 10 ]. The limitations of a systematic review are also discussed in detail. Finally, a conclusion is drawn after evaluating the results and considering limitations [ 10 ].

Discussion of the current article

Systematic reviews with or without a meta-analysis are currently ranked to be the best available evidence in the hierarchy of evidence-based practice [ 21 ]. We have discussed the methodology of a systematic review. A systematic review is classified in the category of filtered information because it appraises the quality of the study and its application in the field of medicine [ 21 ]. However, there are some limitations of the systematic review, as we mentioned earlier in our article. A large randomized controlled trial may provide a better conclusion than a systematic review of many smaller trials due to their larger sample sizes [ 22 ], which help the researchers generalize their conclusions for a bigger population. Other important factors to consider include higher dropout rates in large studies, co-interventions, and heterogeneity among studies included in the review.

As we discussed the limitations of the systematic review and its effect on quality of evidence, there are several tools to rate the evidence, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system [ 22 ]. GRADE provides a structured approach to evaluating the risk of bias, serious inconsistency between studies, indirectness, imprecision of the results, and publication bias [ 22 ]. Another approach used to rate the quality of evidence is a measurement tool to assess systematic reviews (AMSTAR) [ 23 ]. It is also available in several languages [ 23 ].

Conclusions

Despite its limitations, a systematic review can add to the knowledge of the scientific community especially when there are gaps in the existing knowledge. However, conducting a systematic review requires different steps that involve different tools and strategies. It can be difficult at times to access and utilize these resources. A researcher can understand and strategize a systematic review following the different steps outlined in this literature review. However, conducting a systematic review requires a thorough understanding of all the concepts and tools involved, which is an extensive endeavor to be summed up in one article.

The Cochrane Handbook for Systematic Reviews of Interventions and the Center for Reviews and Dissemination (CRD) provide excellent guidance through their insightful and detailed guidelines. We recommend consulting these resources for further guidance.

Given that our article is a narrative review of the scholarly literature, it contains the same limitations as noted for any narrative review. We hope that our review of the means and methods for conducting a systematic review will be helpful in providing basic knowledge to utilize the resources available to the scientific community.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

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Literature Reviews

What is a literature review?
Steps in the Literature Review Process
Define your research question
Determine inclusion and exclusion criteria
Choose databases and search
Review Results
Synthesize Results
Analyze Results
Librarian Support
Artificial Intelligence (AI) Tools

What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field.

A literature review should:

Provide a comprehensive and updated review of the literature;
Explain why this review has taken place;
Articulate a position or hypothesis;
Acknowledge and account for conflicting and corroborating points of view

From S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

Demonstrate how a study fills a gap in research
Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

Organizes or describes a topic
Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
It may be too focused. Some niche studies may miss the bigger picture.
It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

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For help, please contact the librarian for your subject area. We have a guide to library specialists by subject .

Last Updated: Aug 26, 2024 5:59 AM
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How to Conduct a Literature Review: A Guide for Graduate Students

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Traditional or Narrative Reviews

Systematic Reviews
Typology of Reviews
Literature Review Resources
Developing a Search Strategy
What Literature to Search
Where to Search: Indexes and Databases
Finding articles: Libkey Nomad
Finding Dissertations and Theses
Extending Your Searching with Citation Chains
Forward Citation Chains - Cited Reference Searching
Keeping up with the Literature
Managing Your References
Need More Information?

Onwuegbuzie and Frels (pp 24-25, 2016) define four common types of narrative reviews:

General literature review that provides a review of the most important and critical aspects of the current knowledge of the topic. This general literature review forms the introduction to a thesis or dissertation and must be defined by the research objective, underlying hypothesis or problem or the reviewer's argumentative thesis.
Historical literature review which focus on examining research throughout a period of time, often starting with the first time an issue, concept, theory, phenomena emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and to identify the likely directions for future research.
Methodological literature review where the research methods and design are described. These methodological reviews outline the strengths and weaknesses of the methods used and provide future direction
Theoretical literature review which examines how theory shapes or frames research

References and additional resources

Machi, Lawrence A. & Brenda T. McEvoy (2016), The Literature Review: Six steps to success . 3rd edition.; Thousand Oaks, CA: Corwin. Onwuegbuzie, A. J. & Frels, R. (2016) 7 steps to a comprehensive literature review: A multimodal & cultural approach . London: Sage Publications.

<< Previous: Types of Literature Reviews
Next: Systematic Reviews >>

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How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

Search for relevant literature
Evaluate sources
Identify themes, debates, and gaps
Outline the structure
Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

Quick Run-through
Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

Demonstrate your familiarity with the topic and its scholarly context
Develop a theoretical framework and methodology for your research
Position your work in relation to other researchers and theorists
Show how your research addresses a gap or contributes to a debate
Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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See an example

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
Body image, self-perception, self-esteem, mental health
Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

Your university’s library catalogue
Google Scholar
Project Muse (humanities and social sciences)
Medline (life sciences and biomedicine)
EconLit (economics)
Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

What question or problem is the author addressing?
What are the key concepts and how are they defined?
What are the key theories, models, and methods?
Does the research use established frameworks or take an innovative approach?
What are the results and conclusions of the study?
How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
Themes: what questions or concepts recur across the literature?
Debates, conflicts and contradictions: where do sources disagree?
Pivotal publications: are there any influential theories or studies that changed the direction of the field?
Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

Most research has focused on young women.
There is an increasing interest in the visual aspects of social media.
But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

Look at what results have emerged in qualitative versus quantitative research
Discuss how the topic has been approached by empirical versus theoretical scholarship
Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
Critically evaluate: mention the strengths and weaknesses of your sources
Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

Sampling methods
Simple random sampling
Stratified sampling
Cluster sampling
Likert scales
Reproducibility

Statistics

Null hypothesis
Statistical power
Probability distribution
Effect size
Poisson distribution

Research bias

Optimism bias
Cognitive bias
Implicit bias
Hawthorne effect
Anchoring bias
Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

To familiarize yourself with the current state of knowledge on your topic
To ensure that you’re not just repeating what others have already done
To identify gaps in knowledge and unresolved problems that your research can address
To develop your theoretical framework and methodology
To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other academic texts , with an introduction , a main body, and a conclusion .

An annotated bibliography is a list of source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a paper .

Cite this Scribbr article

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McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved September 3, 2024, from https://www.scribbr.com/dissertation/literature-review/

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Literature Reviews

What is a Literature Review?

Steps for Creating a Literature Review
Providing Evidence / Critical Analysis
Challenges when writing a Literature Review
Systematic Literature Reviews

A literature review is an academic text that surveys, synthesizes, and critically evaluates the existing literature on a specific topic. It is typically required for theses, dissertations, or long reports and serves several key purposes:

Surveying the Literature : It involves a comprehensive search and examination of relevant academic books, journal articles, and other sources related to the chosen topic.
Synthesizing Information : The literature review summarizes and organizes the information found in the literature, often identifying patterns, themes, and gaps in the current knowledge.
Critical Analysis : It critically analyzes the collected information, highlighting limitations, gaps, and areas of controversy, and suggests directions for future research.
Establishing Context : It places the current research within the broader context of the field, demonstrating how the new research builds on or diverges from previous studies.

Types of Literature Reviews

Literature reviews can take various forms, including:

Narrative Reviews : These provide a qualitative summary of the literature and are often used to give a broad overview of a topic. They may be less structured and more subjective, focusing on synthesizing the literature to support a particular viewpoint.
Systematic Reviews : These are more rigorous and structured, following a specific methodology to identify, evaluate, and synthesize all relevant studies on a particular question. They aim to minimize bias and provide a comprehensive summary of the existing evidence.
Integrative Reviews : Similar to systematic reviews, but they aim to generate new knowledge by integrating findings from different studies to develop new theories or frameworks.

Importance of Literature Reviews

Foundation for Research : They provide a solid background for new research projects, helping to justify the research question and methodology.

Identifying Gaps : Literature reviews highlight areas where knowledge is lacking, guiding future research efforts.

Building Credibility : Demonstrating familiarity with existing research enhances the credibility of the researcher and their work.

In summary, a literature review is a critical component of academic research that helps to frame the current state of knowledge, identify gaps, and provide a basis for new research.

The research, the body of current literature, and the particular objectives should all influence the structure of a literature review. It is also critical to remember that creating a literature review is an ongoing process - as one reads and analyzes the literature, one's understanding may change, which could require rearranging the literature review.

Paré, G. and Kitsiou, S. (2017) 'Methods for Literature Reviews' , in: Lau, F. and Kuziemsky, C. (eds.) Handbook of eHealth evaluation: an evidence-based approach . Victoria (BC): University of Victoria.

Perplexity AI (2024) Perplexity AI response to Kathy Neville, 31 July.

Royal Literary Fund (2024) The structure of a literature review. Available at: https://www.rlf.org.uk/resources/the-structure-of-a-literature-review/ (Accessed: 23 July 2024).

Library Services for Undergraduate Research (2024) Literature review: a definition . Available at: https://libguides.wustl.edu/our?p=302677 (Accessed: 31 July 2024).

What is a Living Literature Review?

Table of contents.

The number of academic papers doubles every 12 years. This wealth of new knowledge is exciting, but the pace of growth makes keeping up with the latest developments increasingly difficult.

One response to this challenge is “living literature reviews”. At Open Phil, we define a living literature review as a continuously updated online collection of accessible articles that synthesize academic research on a specific topic. These reviews are primarily written by a single expert who is responsible for its quality and accuracy.

Living literature reviews aim to be accessible to readers unfamiliar with a field while maintaining rigor. Unlike news articles that often focus on single, sensational studies, these reviews provide a broader perspective, synthesizing findings from multiple sources. They differ from traditional academic literature reviews by avoiding paywalls, dense jargon, and lengthy formats that pose barriers to non-specialists. Moreover, because they don’t assume familiarity with the assumptions of a field, living literature reviews aim to describe how conclusions were reached, not just what the conclusions are. This transparency allows readers to better understand the research methodology and form their own judgment on the strength of the findings.

Living literature reviews also help readers assess a field by relying on a single individual to provide a consistent voice, perspective, and expert curatorial taste. While these individuals collaborate with other experts in their fields, having one consistent author allows readers to gauge how much they trust the author’s judgment over time.

Finally, living literature reviews leverage digital platforms for hosting and distribution. Websites allow for post-publication corrections and updates, enabling a level of currency that traditional print reviews can’t match. Complementing these, email newsletters and podcasts extend the reach and convenience of learning about academic research.

By making research accessible to a broader audience, living literature reviews can facilitate interdisciplinary connections and inform policy work. They offer insights into work happening in adjacent fields, potentially inspiring collaborations and novel research directions.

Open Philanthropy supports several living literature reviews:

New Things Under the Sun by Matt Clancy: social science research on science and innovation
Existential Crunch by Florian Jehn: academic literature on societal collapse
Some Are Useful by Tom Gebhart: how AI and machine learning are used in different parts of science
Good Questions Review by Paul Kellner: the relationship between academic research and policy impact

We are now seeking pre-proposals from individuals to write living literature reviews . We are particularly interested in reviews on neglected topics relevant to policymaking. Ideal candidates will have a PhD or equivalent expertise in their proposed area. Our support typically allows authors to dedicate a quarter to a third of their time to the project.

If you’re interested in launching your own living literature review, we encourage you to reach out. For more information on how to submit a pre-proposal, please contact [email protected] .

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A systematic literature review of the clinical and socioeconomic burden of bronchiectasis

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Background The overall burden of bronchiectasis on patients and healthcare systems has not been comprehensively described. Here, we present the findings of a systematic literature review that assessed the clinical and socioeconomic burden of bronchiectasis with subanalyses by aetiology (PROSPERO registration: CRD42023404162).

Methods Embase, MEDLINE and the Cochrane Library were searched for publications relating to bronchiectasis disease burden (December 2017–December 2022). Journal articles and congress abstracts reporting on observational studies, randomised controlled trials and registry studies were included. Editorials, narrative reviews and systematic literature reviews were included to identify primary studies. PRISMA guidelines were followed.

Results 1585 unique publications were identified, of which 587 full texts were screened and 149 were included. A further 189 citations were included from reference lists of editorials and reviews, resulting in 338 total publications. Commonly reported symptoms and complications included dyspnoea, cough, wheezing, sputum production, haemoptysis and exacerbations. Disease severity across several indices and increased mortality compared with the general population was reported. Bronchiectasis impacted quality of life across several patient-reported outcomes, with patients experiencing fatigue, anxiety and depression. Healthcare resource utilisation was considerable and substantial medical costs related to hospitalisations, treatments and emergency department and outpatient visits were accrued. Indirect costs included sick pay and lost income.

Conclusions Bronchiectasis causes significant clinical and socioeconomic burden. Disease-modifying therapies that reduce symptoms, improve quality of life and reduce both healthcare resource utilisation and overall costs are needed. Further systematic analyses of specific aetiologies and paediatric disease may provide more insight into unmet therapeutic needs.

Shareable abstract

Bronchiectasis imposes a significant clinical and socioeconomic burden on patients, their families and employers, and on healthcare systems. Therapies that reduce symptoms, improve quality of life and reduce resource use and overall costs are needed. https://bit.ly/4bPCHlp

Introduction

Bronchiectasis is a heterogeneous chronic respiratory disease clinically characterised by chronic cough, excessive sputum production and recurrent pulmonary exacerbations [ 1 ], and radiologically characterised by the abnormal widening of the bronchi [ 2 ]. Bronchiectasis is associated with several genetic, autoimmune, airway and infectious disorders [ 3 ]. Regardless of the underlying cause, the defining features of bronchiectasis are chronic airway inflammation and infection, regionally impaired mucociliary clearance, mucus hypersecretion and mucus obstruction, as well as progressive structural lung damage [ 4 , 5 ]. These features perpetuate one another in a “vicious vortex” leading to a decline in lung function, pulmonary exacerbations and associated morbidity, mortality and worsened quality of life [ 4 , 5 ]. Bronchiectasis can be further categorised into several infective and inflammatory endotypes and is associated with multiple comorbidities and underlying aetiologies [ 6 ].

Bronchiectasis has been described as an emerging global epidemic [ 7 ], with prevalence and incidence rates increasing worldwide [ 8 – 12 ]. The prevalence of bronchiectasis, as well as of the individual aetiologies, varies widely across geographic regions [ 13 ]. In Europe, the reported prevalence ranges from 39.1 (females) and 33.3 (males) cases per 100 000 inhabitants in Spain and 68 (females) and 65 (males) cases per 100 000 inhabitants in Germany, to as high as 566 cases (females) and 486 cases (males) per 100 000 inhabitants in the UK [ 10 – 12 ]. In the US, the average overall prevalence was reported to be 139 cases per 100 000 [ 14 ], in Israel, the prevalence was reported to be 234 cases per 100 000 [ 15 ], and in China the prevalence was reported to be 174 per 100 000 [ 8 ]. Studies show that bronchiectasis prevalence increases with age [ 14 ]. This may increase the socioeconomic impact of bronchiectasis on countries with disproportionately higher number of older citizens. Large registry studies in patients with bronchiectasis have been published from the US (Bronchiectasis Research Registry) [ 16 ], Europe and Israel (European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC)); the largest and most comprehensive report available to date) [ 17 ], India (EMBARC-India) [ 18 , 19 ], Korea (Korean Multicentre Bronchiectasis Audit and Research Collaboration) [ 20 ] and Australia (Australian Bronchiectasis Registry) [ 21 ].

Although there are currently no approved disease-modifying therapies for bronchiectasis [ 4 ], comprehensive clinical care recommendations for the management of patients with bronchiectasis have been published [ 22 , 23 ]. However, the burden that bronchiectasis imposes on patients and their families, as well as on healthcare systems, payers and employers, remains poorly understood. No review to date has used a systematic method to evaluate the overall disease burden of bronchiectasis. This is the first systematic literature review aimed at investigating and synthesising the clinical and socioeconomic burden of bronchiectasis. A better understanding of the overarching burden of bronchiectasis, both overall and by individual aetiologies and associated diseases, will highlight the need for new therapies and assist healthcare systems in planning care and required resources.

The protocol of this systematic review was registered on PROSPERO (reference number: CRD42023404162).

Search strategy

This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines [ 24 ]. Embase, MEDLINE and the Cochrane Library were searched for studies related to the clinical and socioeconomic burden of bronchiectasis (noncystic fibrosis bronchiectasis (NCFBE) and cystic fibrosis bronchiectasis (CFBE)) using the search terms available in supplementary table S1 . Articles written in English and published over a 5-year period (December 2017–December 2022) were included.

Selection criteria

The following article types reporting on prospective and retrospective observational studies, registry studies and randomised controlled trials (only baseline data extracted) were included: journal articles, preprints, research letters, conference proceedings, conference papers, conference abstracts, meeting abstracts and meeting posters. Reviews, literature reviews, systematic reviews and meta-analyses, as well as editorials, commentaries, letters and letters to the editor, were included for the purpose of identifying primary studies. A manual search of references cited in selected articles was performed and references were only included if they were published within the 5 years prior to the primary article being published.

Screening and data extraction

A reviewer screened all titles and abstracts to identify publications for full-text review. These publications then underwent full-text screening by the same reviewer for potential inclusion. A second reviewer independently verified the results of both the title/abstract screen and the full-text screen. Any discrepancies were resolved by a third independent reviewer. Data relating to aetiology, symptoms, disease severity, exacerbations, lung function, infection, comorbidities, patient-reported outcomes (PROs), exercise capacity, mortality, impact on family and caregivers, healthcare resource utilisation (HCRU), treatment burden, medical costs, and indirect impacts and costs, as well as data relating to the patient population, study design, sample size and country/countries of origin, were extracted from the final set of publications into a standardised Excel spreadsheet by one reviewer. Studies were grouped based on the burden measure, and aggregate data (range of reported values) were summarised in table or figure format. For the economic burden section, costs extracted from studies reporting in currencies other than the euros were converted to euros based on the average exchange rate for the year in which the study was conducted.

Data from patients with specific bronchiectasis aetiologies and in children (age limits varied from study to study and included upper age limits of 15, 18, 19 and 20 years) were reported separately, where available. As literature relating to NCFBE and CFBE is generally distinct, any data related to CFBE are reported separately in the tables and text. We conducted subanalyses of key disease burden indicators, in which we extracted data from multicentre studies or those with a sample size >1000 subjects, to try to identify estimates from the most representative datasets. These data from larger and multicentre studies are reported in square brackets in tables 1 – 3 and supplementary tables S2–S7 , where available.

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Prevalence and severity of bronchiectasis symptoms overall, in children, during exacerbations and in individual bronchiectasis aetiologies

Patient-reported outcome scores in patients with bronchiectasis overall and in individual bronchiectasis aetiologies

Healthcare resource utilisation (HCRU) in patients with bronchiectasis overall and in individual bronchiectasis aetiologies

Given the nature of the data included in this systematic literature review (that is, a broad range of patient clinical and socioeconomic characteristics rather than the outcome(s) of an intervention), in addition to the broad range of study types included, meta-analyses to statistically combine data of similar studies were not deemed appropriate and therefore not performed.

Summary of included studies

A total of 1834 citations were retrieved from the Embase, MEDLINE and Cochrane Library databases, of which 1585 unique citations were identified. Abstract/title screening led to the inclusion of 587 citations for full-text screening. Following full-text screening, 149 primary citations and 110 literature reviews, systematic reviews and meta-analyses as well as editorials and letters to the editor remained. From the reference lists of these 110 citations, a further 189 primary citations were identified. These articles were only included if 1) the primary articles contained data relating to the burden of bronchiectasis and 2) the primary articles were published within the 5 years prior to the original article's publication date. In total, 338 publications were considered eligible and included in this review ( supplementary figure S1 ). This included 279 journal articles, 46 congress abstracts and 13 letters to the editor or scientific/research letters. The results are summarised in the sections below. For the results from individual studies, including a description of the patient population, study design, sample size and country/countries of origin, please see the supplemental Excel file .

The most frequently reported aetiologies included post-infectious, genetic (primary ciliary dyskinesia (PCD), alpha-1 antitrypsin deficiency (AATD) and cystic fibrosis (CF)), airway diseases (COPD and asthma), allergic bronchopulmonary aspergillosis (ABPA), aspiration and reflux-related, immunodeficiency and autoimmune aetiologies ( supplementary figure S2 ). However, in up to 80.7% of adult cases and 53.3% of paediatric cases, the aetiology was not determined (referred to as “idiopathic bronchiectasis”) ( supplementary figure S2 ). When limited to larger or multicentre studies, the frequency of idiopathic bronchiectasis ranged from 11.5 to 66.0% in adults and from 16.5 to 29.4% in children. Further details and additional aetiologies can be seen in the supplemental Excel file .

Clinical burden

Symptom burden and severity.

Commonly reported symptoms in patients with bronchiectasis included cough, sputum production, dyspnoea, wheezing and haemoptysis, with these symptoms more prevalent in adults compared with children ( table 1 ). Other reported symptoms included chest discomfort, pain or tightness (both generally and during an exacerbation), fever and weight loss in both adults and children, and fatigue, tiredness or asthenia, appetite loss, and sweating in adults. In children, respiratory distress, hypoxia during an exacerbation, sneezing, nasal and ear discharge, thriving poorly including poor growth and weight loss, exercise intolerance, malaise, night sweats, abdominal pain, recurrent vomiting, and diarrhoea were reported ( supplemental Excel file ). Classic bronchiectasis symptoms such as sputum production (range of patients reporting sputum production across all studies: 22.0–92.7%) and cough (range of patients reporting cough across all studies: 24.0–98.5%) were not universally reported ( table 1 ).

In a study comparing bronchiectasis (excluding CFBE) in different age groups (younger adults (18–65 years), older adults (66–75 years) and elderly adults (≥76 years) [ 63 ]), no significant differences across age groups were reported for the presence of cough (younger adults: 73.9%; older adults: 72.8%; elderly adults: 72.9%; p=0.90), sputum production (younger adults: 57.8%; older adults: 63.8%; elderly adults: 6.0%; p=0.16) or haemoptysis (younger adults: 16.5%; older adults: 19.3%; elderly adults: 16.3%; p=0.47).

Disease severity

Disease severity was reported according to several measures including the bronchiectasis severity index (BSI), the forced expiratory volume in 1 s (FEV 1 ), Age, Chronic Colonisation, Extension, Dyspnoea (FACED) score and the Exacerbations-FACED (E-FACED) score, all of which are known to be associated with future exacerbations, hospitalisations and mortality ( supplementary table S2 and the supplemental Excel file ). Up to 78.7, 41.8 and 40.8% of patients with bronchiectasis reported severe disease according to the BSI, FACED score and E-FACED score, respectively ( supplementary table S2 ). In most studies, severity scores were greater among people with bronchiectasis secondary to COPD or post-tuberculosis (TB) than idiopathic bronchiectasis ( supplementary table S2 ). No data relating to disease severity were reported for CFBE specifically.

Exacerbations

The number of exacerbations experienced by patients with bronchiectasis in the previous year, per year and during follow-up are presented in figure 1 . For further details, please see the supplemental Excel file . Two studies reported exacerbation length in patients with bronchiectasis; this ranged from 11 to 16 days (both small studies; sample sizes of 191 and 32, respectively) [ 25 , 64 ]. A study in children with NCFBE reported a median of one exacerbation in the previous year. Additionally, the same study reported that 31.1% of children with bronchiectasis experienced ≥3 exacerbations per year [ 65 ].

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Range of bronchiectasis exacerbations in the previous year, per year and in the first and second years of follow-up. # : Two studies reported significant differences in the number of exacerbations experienced in the previous year across individual aetiologies. Study 1 [ 90 ]: Patients with idiopathic bronchiectasis had significantly fewer exacerbations in the previous year compared with other aetiologies (primary ciliary dyskinesia (PCD), COPD and post-infectious) (p<0.021). Study 2 [ 33 ]: significant difference between post-tuberculosis (TB) bronchiectasis (mean: 2.8) and other aetiologies excluding idiopathic bronchiectasis (mean: 1.7) (p<0.05).

Lung function

Reduced lung function was reported across several different measures in adults and children with bronchiectasis overall, including FEV 1 (absolute values and % predicted), forced vital capacity (FVC; absolute values and % pred) and lung clearance index (adults only) ( supplementary table S3 and the supplemental Excel file ). In most studies, lung function was lowest among people with post-TB bronchiectasis and bronchiectasis secondary to COPD or PCD ( supplementary table S2 ). Additional measures of lung function are detailed in the supplemental Excel file . Lung clearance index, considered more sensitive than spirometry to early airway damage, was elevated in two studies in adults with bronchiectasis, with a range of 9.0–12.8 (normal: 6–7 or less) [ 66 , 67 ].

In a study comparing bronchiectasis (people with CFBE excluded) in different age groups, elderly adults (≥76 years) had significantly lower FEV 1 % pred (median: 67) compared with both younger (18–65 years; median: 78) and older adults (66–75 years; median: 75) (p<0.017 for both comparisons) [ 63 ]. FVC % pred was found to be significantly lower in elderly adults (mean: 65) compared with both younger adults (median: 78) and older adults (median: 75) (p<0.017 for both comparisons) [ 63 ].

Chronic infection with at least one pathogen was reported in 22.3–79.6% of patients with bronchiectasis, although each study defined chronic infection differently (number of studies: 20). When limited to larger or multicentre studies, chronic infection with at least one pathogen was reported in 10.7–54.5% of patients with bronchiectasis (number of studies: 12). In two studies in NCFBE, significant differences in the proportion of patients chronically infected with at least one pathogen were reported across aetiologies (p<0.001 for both studies) [ 68 , 69 ]. Patients with post-infectious (other than TB) bronchiectasis (34.9%) [ 68 ] and patients with PCD-related bronchiectasis (68.3%) [ 69 ] had the highest prevalence of chronic infection.

The most commonly reported bacterial and fungal pathogens are shown in supplementary table S4 . The two most common bacterial pathogens were Pseudomonas ( P .) aeruginosa and Haemophilus ( H. ) influenzae . In several studies, more patients with PCD, TB and COPD as the aetiology of their bronchiectasis reported infection with P. aeruginosa . Additionally, in one study, significantly more children with CFBE had P. aeruginosa infection compared with children with NCFBE [ 70 ]. Further details and additional pathogens are reported in the supplemental Excel file .

Diversity of the sputum microbiome was assessed in two studies. In the first study in people with bronchiectasis (people with CFBE excluded), reduced microbiome alpha diversity (defined as the relative abundance of microbial species within a sample), particularly associated with Pseudomonas or Proteobacteria dominance, was associated with greater disease severity, increased frequency and severity of exacerbations, and a higher risk of mortality [ 71 ]. In the second study (unknown whether people with CFBE were excluded), a lower Shannon–Wiener diversity index (a measure of species diversity, with lower scores indicating lower diversity) score was associated with multiple markers of disease severity, including a higher BSI score (p=0.0003) and more frequent exacerbations (p=0.008) [ 72 ].

In a study comparing bronchiectasis (people with CFBE excluded) in different age groups (younger adults: 18–65 years; older adults: 66–75 years; elderly adults: ≥76 years) [ 63 ], chronic infection with H. influenzae was reported in 18.3% of younger adults, 12.8% of older adults and 8.8% of elderly adults, and chronic infection with Streptococcus ( Str. ) pneumoniae was reported in 5.3% of younger adults, 2.8% of older adults and 1.3% of elderly adults. For both of the above, the prevalence was significantly higher in younger adults compared with elderly adults (p<0.017 for both comparisons). However, no significant differences across age groups were reported for P. aeruginosa , Moraxella catarrhalis or Staphylococcus ( Sta .) aureus chronic infection.

P. aeruginosa infection was significantly associated with reduced FEV 1 [ 73 ], more severe disease [ 74 ], more frequent exacerbations [ 35 , 49 , 75 , 76 ], increased hospital admissions, reduced quality of life based on St. George's Respiratory Questionnaire (SGRQ) and increased and 4-year mortality [ 49 , 76 ]. Additionally, in a study reporting healthcare use and costs in the US between 2007–2013, healthcare costs and hospitalisation costs were found to be increased in patients infected with P. aeruginosa ($56 499 and $41 972 more than patients not infected with P. aeruginosa , respectively) [ 77 ]. In the same study, HCRU was also higher in patients infected with P. aeruginosa (fivefold increase in the number of hospitalisations and 84% more emergency department (ED) visits compared with patients not infected with P. aeruginosa ) [ 77 ].

Comorbidities

The most frequently reported comorbidities included cardiovascular (including heart failure, cerebrovascular disease and hypertension), respiratory (including asthma, COPD and sinusitis), metabolic (including diabetes and dyslipidaemia), malignancy (including haematological and solid malignancies), bone and joint-related (including osteoporosis and rheumatological disease), neurological (including anxiety and depression), renal, hepatic, and gastrointestinal comorbidities ( supplementary table S5 ). No data relating to comorbidities were reported for CFBE specifically. For further details and additional comorbidities, please see the supplemental Excel file .

In a study comparing bronchiectasis (people with CFBE excluded) in different age groups (younger adults: 18–65 years; older adults: 66–75 years; elderly adults: ≥76 years), younger adults had a significantly lower prevalence of diabetes compared with older adults, a significantly lower prevalence of stroke compared with elderly adults and a significantly lower prevalence of heart failure, solid tumours and renal failure compared with both older and elderly adults (p<0.0017 for all comparisons). Additionally, the prevalence of COPD was significantly lower in both younger and older adults compared with elderly adults (p<0.017) [ 63 ]. In studies reporting in children with bronchiectasis, the prevalence of comorbid asthma ranged from 22.2 to 25.8% [ 65 , 78 ] and the prevalence of sinusitis was reported to be 12.7% in a single study [ 79 ].

Charlson comorbidity index (CCI)

CCI scores can range from 0 to 37, with higher scores indicating a decreased estimate of 10-year survival. In this review, CCI scores ranged from 0.7 to 6.6 in studies reporting means (number of studies: 7). In one study, adults with bronchiectasis (people with CFBE excluded) who experienced ≥2 exacerbations per year were found to have significantly higher CCI scores (3.3) compared with patients who experienced less than two exacerbations per year (2.2) (p=0.001) [ 35 ]. In another study in adults with bronchiectasis (people with CFBE excluded), CCI scores increased significantly with increasing disease severity, with patients with mild (FACED score of 0–2), moderate (FACED score of 3–4) and severe (FACED score of 5–7) bronchiectasis reporting mean CCI scores of 3.9, 5.7 and 6.3, respectively [ 80 ]. No CCI scores were reported for CFBE specifically.

Prevalence of comorbidities in patients with bronchiectasis compared with control individuals

Several studies reported a higher prevalence of cardiovascular comorbidities. such as heart failure [ 81 ], stroke [ 82 , 83 ] and hypertension [ 82 – 84 ] in patients with bronchiectasis compared with a matched general population or healthy controls. Conversely, several additional studies reported no significant differences [ 81 , 85 , 86 ]. Two large studies reported an increased prevalence of diabetes in patients with bronchiectasis compared with nonbronchiectasis control groups [ 83 , 84 ]; however, three additional smaller studies reported no significant differences [ 81 , 82 , 86 ]. The prevalence of gastro–oesophageal reflux disease was found to be significantly higher in patients with bronchiectasis compared with matched nonbronchiectasis controls in one study [ 87 ], but no significant difference was reported in a second study [ 85 ]. Both anxiety and depression were found to be significantly more prevalent in patients with bronchiectasis compared with matched healthy controls in one study [ 55 ]. Lastly, two large studies reported an increased prevalence of asthma [ 84 , 87 ] and five studies reported a significantly higher prevalence of COPD [ 81 , 82 , 84 , 85 , 87 ] in patients with bronchiectasis compared with matched nonbronchiectasis controls or the general population. A smaller study reported conflicting evidence whereby no significant difference in the prevalence of asthma in patients with bronchiectasis compared with matched controls was reported [ 85 ].

Socioeconomic burden

Patient-reported outcomes.

Health-related quality of life (HRQoL), fatigue, anxiety and depression were reported across several PRO measures and domains. The most frequently reported PROs are discussed in further detail in the sections below ( table 2 ). Further details and additional PROs can be seen in the supplemental Excel file .

In a study comparing bronchiectasis (people with CFBE excluded) in different age groups (younger adults: 18–65 years; older adults: 66–75 years; elderly adults: ≥76 years), the median SGRQ total score was significantly higher in elderly adults (50.8) compared with younger adults (36.1), indicating a higher degree of limitation (p=0.017) [ 63 ].

In a study that reported Leicester Cough Questionnaire (LCQ) scores in men and women with bronchiectasis (people with CFBE excluded) separately, women had significantly lower LCQ total scores (14.9) when compared with men (17.5) (p=0.006), indicating worse quality of life [ 88 ]. Additionally, women had significantly lower scores across all three LCQ domains (p=0.014, p=0.005 and p=0.011 for physical, psychological and social domains, respectively) [ 88 ].

Exercise capacity

Exercise capacity in patients with bronchiectasis was reported using walking tests namely the 6-minute walk test (6MWT) and the incremental shuttle walk test (ISWT) ( supplementary table S6 ). The 6MWT data from patients with bronchiectasis generally fell within the normal range for healthy people; however, the ISWT data was below the normal range for healthy people ( supplementary table S6 ). Studies also reported on daily physical activity, daily sedentary time and number of steps per day in patients with bronchiectasis, and in children specifically ( supplementary table S6 ). No data relating to disease severity were reported for CFBE specifically. Further details can be seen in the supplemental Excel file .

Exercise capacity in patients with bronchiectasis compared with control individuals

In one study, the ISWT distance was reported to be significantly lower in patients with NCFBE compared with healthy controls (592.6 m versus 882.9 m; difference of ∼290 m; p<0.001) [ 89 ]. Additionally, patients with bronchiectasis spent significantly less time on activities of moderate and vigorous intensity compared with healthy controls (p=0.030 and 0.044, respectively) [ 89 ]. Lastly, a study reported that patients with NCFBE had a significantly lower step count per day compared with healthy controls (p<0.001) [ 89 ].

Mortality rate during study period

Mortality ranged from 0.24 to 67.6%; however, it should be noted that the study duration differed across studies. When limited to larger or multicentre studies, the mortality rate ranged from 0.24 to 28.1%. One study reported more deaths in patients with NCFBE (9.1%; 5.9-year mean follow-up period) compared with patients without bronchiectasis (0.8%; 5.4-year mean follow-up period) [ 84 ]. In one study, significantly more patients with COPD-related bronchiectasis died (37.5%) compared with other aetiologies (19.0%) (3.4-year mean follow-up period; p<0.001). After adjusting for several factors, multivariate analysis showed that the diagnosis of COPD as the primary cause of bronchiectasis increased the risk of death by 1.77 compared with the patients with other aetiologies [ 41 ]. Similarly, in another study, COPD-associated bronchiectasis was associated with higher mortality (55%) in multivariate analysis as compared with other aetiologies (rheumatic disease: 20%; post-infectious: 16%; idiopathic: 14%; ABPA: 13%; immunodeficiency: 11%) (hazard ratio 2.12, 95% CI 1.04–4.30; p=0.038; 5.2-year median follow-up period) [ 90 ].

Mortality rates by year

The 1-, 2-, 3-, 4- and 5-year mortality rates in patients with bronchiectasis (people with CFBE excluded, unless unspecified) ranged from 0.0 to 12.3%, 0.0 to 13.0%, 0.0 to 21.0%, 5.5 to 39.1% and 12.4 to 53.0%, respectively (number of studies: 9, 4, 7, 1 and 4, respectively). When limited to larger or multicentre studies, the 1-, 2-, 3- and 5-year mortality rates ranges were 0.4–7.9%, 3.9–13.0%, 3.7–21.0% and 12.4–53.0% (no 4-year mortality data from larger or multicentre studies). No data relating to mortality rates were reported for CFBE specifically.

Two studies reported mortality rate by bronchiectasis aetiology (people with CFBE excluded). In the first study, no significant difference in the 4-year mortality rate was reported across aetiologies (p=0.7; inflammatory bowel disease: 14.3%; post-TB: 13.4%; rheumatoid arthritis: 11.4%; idiopathic or post-infectious: 10.1%; ABPA: 6.1%; other aetiologies: 6.1%) [ 49 ]. In the second study, patients with post-TB bronchiectasis had a significantly higher 5-year mortality rate (30.0%) compared with patients with idiopathic bronchiectasis (18.0%) and other aetiologies (10.0%) (p<0.05 for both comparisons) [ 32 ].

In-hospital and intensive care unit mortality

In-hospital mortality ranged from 2.9 to 59.3% in patients with bronchiectasis (people with CFBE excluded, unless unspecified) hospitalised for an exacerbation or for other reasons (number of studies: 7). When limited to larger or multicentre studies, in-hospital mortality rate was reported in only one study (33.0%). One study reported mortality in bronchiectasis patients admitted to a tertiary care centre according to aetiology; in-hospital mortality was highest in patients with post-pneumonia bronchiectasis (15.8%), followed by patients with idiopathic (7.1%) and post-TB (2.6%) bronchiectasis. No deaths were reported in patients with COPD, ABPA or PCD aetiologies [ 42 ]. Intensive care unit mortality was reported in two studies and ranged from 24.6 to 36.1% [ 62 , 91 ]. No data relating to mortality rates were reported for CFBE specifically.

Impact on family and caregivers

Only two studies discussed the impact that having a child with bronchiectasis has on parents/caregivers. In the first study, parents of children with bronchiectasis (not specified whether children with CFBE were excluded) were more anxious and more depressed according to both the Hospital Anxiety and Depression Scale (HADS) and the Centre of Epidemiological Studies depression scale, compared with parents of children without any respiratory conditions (both p<0.001; sample size of 29 participants) [ 53 ]. In the second study, parents or carers of children with bronchiectasis (multicentre study with a sample size of 141 participants; children with CFBE excluded) were asked to vote for their top five greatest concerns or worries; the most common worries or concerns that were voted for by over 15% of parents were “impact on his/her adult life in the future, long-term effects, normal life” (29.8%), “ongoing declining health” (25.5%), “the cough” (24.8%), “impact on his/her life now as a child (play, development)” (24.1%), “lack of sleep/being tired” (24.1%), “concerns over aspects of antibiotic use” (22.7%), “missing school or daycare” (17.7%) and “breathing difficulties/shortness of breath” (16.3%) [ 92 ].

HCRU in terms of hospitalisations, ED visits, outpatient visits and length of stay overall and by bronchiectasis aetiology are reported in table 3 . No data relating to HCRU were reported for CFBE specifically.

In a study in children with bronchiectasis (children with CFBE excluded), 30.0% of children were hospitalised at least once in the previous year [ 65 ]. The median number of hospitalisations per year was 0 (interquartile range: 0–1) [ 65 ]. In another study, the mean length of hospital stay for children with bronchiectasis was 6.7 days (standard deviation: 4.8 days) [ 93 ]. In a study comparing bronchiectasis (people with CFBE excluded) in different age groups, significantly more elderly adults (≥76 years; 26.0%) were hospitalised at least once during the first year of follow-up compared with younger adults (18–65 years; 17.0%) and older adults (66–75 years; 17.0%) (p<0.017 for both comparisons) [ 63 ]. Additionally, length of stay was found to be significantly longer in male patients (mean: 17.6 days) compared with female patients (mean: 12.5 days) (p=0.03) [ 94 ].

HCRU in patients with bronchiectasis compared with control individuals

Length of stay was found to be 38% higher in patients with bronchiectasis (mean: 15.4 days; people with CFBE excluded) compared with patients with any other respiratory illness (mean: 9.6 days) (p<0.001) [ 94 ]. In a study reporting on HCRU in patients with bronchiectasis (people with CFBE excluded) over a 3-year period (Germany; 2012–2015) [ 85 ], a mean of 24.7 outpatient appointments per patient were reported; there was no significant difference in the number of outpatient appointments between patients with bronchiectasis and matched controls (patients without bronchiectasis matched by age, sex and distribution, and level of comorbidities) (mean: 23.4) (p=0.12). When assessing specific outpatient appointments over the 3-year period, patients with bronchiectasis attended a mean of 9.2 general practitioner appointments, 2.9 radiology appointments, 2.5 chest physician appointments and 0.8 cardiologist appointments. Patients with bronchiectasis had significantly fewer general practitioner appointments compared with matched controls (mean: 9.8) (p=0.002); however, they had significantly more radiology appointments (mean for matched controls: 2.3) and chest physician appointments (mean for matched controls: 1.4) compared with matched controls (p<0.001 for both comparisons).

Hospital admission rates

In England, Wales and Northern Ireland, the crude hospital admission rate in 2013 was 88.4 (95% CI 74.0–105.6) per 100 000 person-years [ 91 ]. In New Zealand (2008–2013), the crude and adjusted hospital admission rates were 25.7 and 20.4 per 100 000 population, respectively [ 95 ]. Lastly, in Australia and New Zealand (2004–2008) the hospital admission rate ranged from 0.7 to 2.9 per person-year [ 96 ]. In all of the abovementioned studies, people with CFBE were excluded.

Treatment burden

In two studies, the percentage of patients with bronchiectasis receiving any respiratory medication at baseline ranged from 60.8 to 85.7% [ 97 , 98 ]. Additionally, in a study comparing healthcare costs in patients with bronchiectasis before and after confirmation of P. aeruginosa infection, mean pharmacy visits in the year preceding diagnosis were reported to be 23.2; this increased significantly by 56.5% to 36.2 in the year post-diagnosis (p<0.0001) [ 99 ]. In another study, patients with bronchiectasis were prescribed a mean of 12 medications for bronchiectasis and other comorbidities [ 100 ]. In all of the abovementioned studies, people with CFBE were excluded. The most frequently reported respiratory treatments can be seen in supplementary table S7 . These included antibiotics (including macrolides), corticosteroids, bronchodilators, mucolytics and oxygen. No treatment data were reported for CFBE specifically. Other respiratory treatments included saline, anticholinergics and leukotriene receptor antagonists ( supplemental Excel file ).

In studies reporting in children with bronchiectasis, 23.9% of children were receiving any bronchodilator at baseline [ 101 ], 9.0–21.7% of children were receiving inhaled corticosteroids (ICS) at baseline [ 101 , 102 ], 4.3% of children were receiving oral corticosteroids at baseline [ 101 ] and 12.1% of children were receiving long-term oxygen therapy [ 103 ].

Medical and nonmedical indirect impacts and costs

Medical costs for bronchiectasis included overall costs, hospitalisation costs, ED visits and outpatient visit costs and costs of treatment; indirect impacts and costs included sick leave and sick pay, missed work and income loss for caregivers, and missed school or childcare for children ( table 4 and the supplemental Excel file ). People with CFBE were excluded from all of the studies in table 4 below. In studies reporting in currencies other than the €, costs were converted to € based on the average exchange rate for the year in which the study was conducted.

Bronchiectasis-related medical costs and indirect impacts and costs (individual studies)

No review to date has systematically evaluated the overall disease burden of bronchiectasis. Here, we present the first systematic literature review that comprehensively describes the clinical and socioeconomic burden of bronchiectasis overall and across individual aetiologies and associated diseases. A total of 338 publications were included in the final analysis. Together, the results indicate that the burden of clinically significant bronchiectasis on patients and their families, as well as on healthcare systems, is substantial, highlighting the urgent need for new disease-modifying therapies for bronchiectasis.

Bronchiectasis is associated with genetic, autoimmune, airway and infectious disorders. However, in many patients with bronchiectasis, an underlying aetiology cannot be identified (idiopathic bronchiectasis) [ 1 , 3 , 4 ]. This is supported by the results of this systematic literature review, in which up to 80.7% of patients were reported to have idiopathic bronchiectasis. The results are in line with those reported in a systematic literature review of bronchiectasis aetiology conducted by G ao et al. [ 13 ] (studies from Asia, Europe, North and South America, Africa and Oceania included) in which an idiopathic aetiology was reported in approximately 45% of patients with bronchiectasis, with a range of 5–82%. The maximum of 80.7% of patients with idiopathic bronchiectasis identified by this systematic literature review is much higher than in the recent report on the disease characteristics of the EMBARC where idiopathic bronchiectasis was the most common aetiology and reported in only ∼38% of patients with bronchiectasis [ 17 ]. This highlights the importance of sample size and geographic variation (80.7% reported from a single-country study with a small sample size versus ∼38% reported from a continent-wide study with a large sample size). Nevertheless, identifying the underlying aetiology is a recommendation of bronchiectasis guidelines as this can considerably alter the clinical management and prognosis [ 23 , 110 ]. Specific therapeutic interventions may be required for specific aetiologies, such as ICS for people with asthma-related bronchiectasis, antifungal treatment for those with ABPA-associated bronchiectasis and immunoglobulin replacement therapy for those with common variable immunodeficiency-related bronchiectasis [ 23 , 111 ]. Indeed, an observational study has shown that identification of the underlying aetiology affected management in 37% of people with bronchiectasis [ 112 ]. Future studies to determine the impact of identifying the underlying aetiology on management and prognosis are needed to fully understand its importance.

Patients with bronchiectasis experienced a significant symptom burden, with dyspnoea, cough, wheezing, sputum production and haemoptysis reported most commonly. These symptoms were also reported in children with bronchiectasis at slightly lower frequencies. Dealing with bronchiectasis symptoms are some of the greatest concerns from a patient's perspective. In a study assessing the aspects of bronchiectasis that patients found most difficult to deal with, sputum, dyspnoea and cough were the first, fifth and sixth most common answers, respectively [ 113 ]. Some aetiologies were reported to have a higher prevalence of certain symptoms. For example, in single studies, patients with PCD-related bronchiectasis were found to have a significantly higher prevalence of cough and wheezing [ 39 ], patients with COPD-related bronchiectasis were found to have a significantly higher prevalence of sputum production [ 41 ], and patients with post-TB bronchiectasis were found to have a higher prevalence of haemoptysis [ 30 ] compared with other aetiologies. Together, these results highlight the need for novel treatments that reduce the symptom burden of bronchiectasis. They also highlight the importance of teaching patients to perform and adhere to regular nonpharmacological interventions, such as airway clearance using physiotherapy techniques, which have been shown to improve cough-related health status and chronic sputum production [ 110 ]. Future studies assessing when airway clearance techniques should be started, and which ones are the most effective, are a research priority [ 113 ].

The burden of exacerbations in patients with bronchiectasis was high, with patients experiencing three or more exacerbations in the previous year (up to 73.6%), per year (up to 55.6%) or in the first year of follow-up (up to 32.4%). Few studies reported significant differences between aetiologies. Importantly, exacerbations are the second-most concerning aspect of bronchiectasis from the patient's perspective [ 113 ]. Patients with frequent exacerbations have more frequent hospitalisations and increased 5-year mortality [ 114 ] and exacerbations are also associated with poorer quality of life [ 114 , 115 ]. Therefore, prevention of exacerbations is of great importance in the management of bronchiectasis [ 116 ]. The exact cause of exacerbations in bronchiectasis (believed to be multifactorial) is not fully understood due a lack of mechanistic studies [ 116 ]. Future studies into the causes and risk factors for exacerbations [ 113 ] may lead to improvements in their prevention.

Many patients with bronchiectasis, including children, experienced chronic infections with bacterial pathogens such as P. aeruginosa , H. influenzae , Sta. aureus and Str. pneumoniae as well as non-tuberculous mycobacteria. Importantly, P. aeruginosa infection was significantly associated with more severe disease, reduced lung function and quality of life, and increased exacerbations, hospital admission, morality, HCRU and healthcare costs. Due to the clear and consistent association between P. aeruginosa and poor outcomes, patients with chronic P. aeruginosa colonisation should be considered to be at a higher risk of bronchiectasis-related complications [ 110 ]. Additionally, regular sputum microbiology screening should be performed in people with clinically significant bronchiectasis to detect new isolation of P. aeruginosa [ 110 ]; in which case, patients should be offered eradication antibiotic treatment [ 23 ]. Eradication of P. aeruginosa is not only of clinical importance, but also of economic importance due to the associated HCRU and healthcare costs. As such, a better understanding of the key factors leading to P. aeruginosa infection is a priority for future research [ 113 ].

Bronchiectasis markedly impacted HRQoL across several PROs including the SGRQ, Quality of Life–Bronchiectasis score, LCQ, COPD Assessment Test and Bronchiectasis Health Questionnaire. In children with bronchiectasis, significantly lower quality of life (according to the Paediatric Quality of Life Inventory score) compared with age-matched controls was reported [ 53 ]. The majority of studies reporting HRQoL in individual aetiologies and associated diseases either reported in a single aetiology, did not perform any statistical analyses to compare aetiologies, or reported no significant differences across aetiologies. Patients also experienced mild-to-moderate anxiety and depression according to the HADS-Anxiety, HADS-Depression and 9-question Patient Health Questionnaire scores, with very limited data reported in individual aetiologies. When compared with healthy controls, anxiety and depression were found to be significantly more prevalent in patients with bronchiectasis [ 55 ]. Additionally, exercise capacity was reduced, with patients with bronchiectasis reported to spend significantly less time on activities of moderate and vigorous intensity and have a significantly lower step count per day compared with healthy controls [ 89 ]. Improvements in anxiety, depression and exercise capacity are important priorities for people with bronchiectasis; in a study assessing the aspects of bronchiectasis that patients found most difficult to manage, “not feeling fit for daily activities”, anxiety and depression were the fourth, eighth and ninth most common answers, respectively [ 113 ].

The studies relating to HCRU and costs in this review were heterogeneous in terms of methodology, time period, country and currency, making them challenging to compare. Nevertheless, this study found that HCRU was substantial, with patients reporting a maximum of 1.3 hospitalisation, 1.3 ED and 21.0 outpatient visits per year. Length of stay was found to be significantly longer in patients with bronchiectasis compared with patients with any other respiratory illness in one study [ 91 ]. In another study, patients with bronchiectasis reported significantly more specialist appointments (radiologist appointments and chest physician appointments) compared with matched controls [ 85 ]. Patients with bronchiectasis also experienced a significant treatment burden, with up to 36.4, 58.0 and 83.0% of patients receiving long-term inhaled antibiotics, oral antibiotics and macrolides, respectively, up to 80.4% receiving long-term ICS and up to 61.7% and 81.4% receiving long-term long-acting muscarinic antagonists and long-acting beta agonists, respectively. Wide ranges of treatment use were reported in this study, which may reflect geographic variation in treatment patterns. Heterogeneous treatment patterns across Europe were observed in the EMBARC registry data with generally higher medication use in the UK and Northern/Western Europe and lower medication use in Eastern Europe (inhaled antibiotics: 1.8–8.9%; macrolides: 0.9–24.4%; ICS: 37.2–58.5%; long-acting beta agonists: 42.7–52.8%; long-acting muscarinic antagonists: 26.5–29.8%) [ 17 ]. Similarly, data from the Indian bronchiectasis registry indicate that the treatment of bronchiectasis in India is also diverse [ 19 ]. Furthermore, in a comparison of the European and Indian registry data, both long-term oral and inhaled antibiotics were more commonly used in Europe compared with India [ 19 ].

Cost varied widely across studies. However, patients, payers and healthcare systems generally accrued substantial medical costs due to hospitalisations, ED visits, outpatient visits, hospital-in-the-home and treatment-related costs. Other medical costs incurred included physiotherapy and outpatient remedies (including breathing or drainage techniques), outpatient medical aids (including nebulisers and respiration therapy equipment) and the cost of attending convalescence centres. Only one study compared the medical costs in patients with bronchiectasis and matched controls (age, sex and comorbidities) and found that patients with bronchiectasis had significantly higher total direct medical expenditure, hospitalisation costs, treatment costs for certain medications and costs associated with outpatient remedies and medical aids [ 85 ]. Bronchiectasis was also associated with indirect impacts and costs, including sick leave, sick pay and income lost due to absenteeism and missed work, and lost wages for caregivers of patients with bronchiectasis. Children with bronchiectasis also reported absenteeism from school or childcare.

Our findings regarding HRCU and costs in bronchiectasis are mirrored by a recent systematic literature review by R oberts et al . [ 117 ] estimating the annual economic burden of bronchiectasis in adults and children over the 2001–2022 time period. R oberts et al . [ 117 ] found that annual total healthcare costs per adult patient ranged from €3027 to €69 817 (costs were converted from USD to € based on the average exchange rate in 2021), predominantly driven by hospitalisation costs. Likewise, we report annual costs per patient ranging from €218 to €51 033, with annual hospital costs ranging from €1215 to €27 612 (adults and children included) ( table 4 ). Further, R oberts et al . [ 117 ] reports a mean annual hospitalisation rate ranging from 0.11 to 2.9, which is similar to our finding of 0.03–1.3 hospitalisations per year ( table 3 ). With regard to outpatient visits, R oberts et al . [ 117 ] reports a mean annual outpatient respiratory physician attendance ranging from 0.83 to 6.8 visits, whereas we report a maximum of 21 visits per year ( table 3 ). It should be noted, however, that our value is not restricted to visits to a respiratory physician. With regard to indirect annual costs per adult patient, R oberts et al . [ 117 ] reports a loss of income because of illness of €1109–€2451 (costs were converted from USD to € based on the average exchange rate in 2021), whereas we report a figure of ∼€1410 ( table 4 ). Finally, burden on children is similarly reported by us and R oberts et al . [ 117 ], with children missing 12 days of school per year per child ( table 4 ).

Limitations of this review and the existing literature

Due to the nature of this systematic literature review, no formal statistical analyses or formal risk of bias assessments were performed.

Several limitations within the existing literature were identified. Firstly, the vast majority of studies reported patients with NCFBE overall, with limited availability of literature reporting on individual aetiologies and associated disease. Furthermore, where this literature was available, it was limited to a handful of individual aetiologies and associated diseases, and in many of these studies, no statistical analyses to compare different aetiologies and associated disease were performed. Additionally, the methods used to determine aetiologies within individual studies may have differed. Literature on NCFBE and CFBE has traditionally been very distinct; as such, most of the studies included in this review have excluded people with CF. As the general term “CF lung disease” was not included in our search string in order to limit the number of hits, limited data on CFBE are included in this review. Bronchiectasis remains largely under-recognised and underdiagnosed, thus limiting the availability of literature. There is a particular knowledge gap with respect to paediatric NCFBE; however, initiatives such as the Children's Bronchiectasis Education Advocacy and Research Network (Child-BEAR-Net) ( www.improvebe.org ) are aiming to create multinational registries for paediatric bronchiectasis.

There were variations in the amount of literature available for the individual burdens. While there was more literature available on the clinical burden of bronchiectasis, economic data (related to both medical costs and indirect costs) and data on the impact of bronchiectasis on families and caregivers, were limited. Additionally, cost comparisons across studies and populations were difficult due to differences in cost definitions, currencies and healthcare systems.

Sample sizes of the studies included in this systematic literature review varied greatly, with the majority of studies reporting on a small number of participants. Furthermore, many of the studies were single-centre studies, thus limiting the ability to make generalisations about the larger bronchiectasis population, and cross-sectional, thus limiting the ability to assess the clinical and socioeconomic burden of bronchiectasis over a patient's lifetime. Furthermore, there may be potential sex/gender bias in reporting that has not been considered in this systematic literature review.

Finally, for many of the reported outcomes, data varied greatly across studies, with wide estimates for the frequency of different aetiologies and comorbidities as well as disease characteristics such as exacerbations and healthcare costs noted. This reflects the heterogeneity of both the study designs (including sample size and inclusion and exclusion criteria) and the study populations themselves. Additionally, the use of non-standardised terms across articles posed a limitation for data synthesis. Systematic collection of standardised data across multiple centres, with standardised inclusion and exclusion criteria such as that being applied in international registries, is likely to provide more accurate estimates than those derived from small single-centre studies.

Conclusions

Collectively, the evidence identified and presented in this systematic literature review show that bronchiectasis imposes a significant clinical and socioeconomic burden on patients and their families and employers, as well as on healthcare systems. Disease-modifying therapies that reduce symptoms, improve quality of life, and reduce both HCRU and overall costs are urgently needed. Further systematic analyses of the disease burden of specific bronchiectasis aetiologies and associated disease (particularly PCD-, COPD- and post-TB-associated bronchiectasis, which appear to impose a greater burden in some aspects) and paediatric bronchiectasis (the majority of data included in this study were obtained from adults) may provide more insight into the unmet therapeutic needs for these specific patient populations.

Questions for future research

Further research into the clinical and socioeconomic burden of bronchiectasis for individual aetiologies and associated diseases is required.

Supplementary material

Supplementary Material

Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

Supplementary figures and tables ERR-0049-2024.SUPPLEMENT

Supplementary Excel file ERR-0049-2024.SUPPLEMENT

Acknowledgements

Laura Cottino, PhD, of Nucleus Global, provided writing, editorial support, and formatting assistance, which was contracted and funded by Boehringer Ingelheim.

Provenance: Submitted article, peer reviewed.

Conflict of interest: The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE). J.D. Chalmers has received research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis, Insmed and Trudell, and received consultancy or speaker fees from Antabio, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer, Trudell and Zambon. M.A. Mall reports research grants paid to their institution from the German Research Foundation (DFG), German Ministry for Education and Research (BMBF), German Innovation Fund, Vertex Pharmaceuticals and Boehringer Ingelheim; consultancy fees from AbbVie, Antabio, Arrowhead, Boehringer Ingelheim, Enterprise Therapeutics, Kither Biotec, Prieris, Recode, Santhera, Splisense and Vertex Pharmaceuticals; speaker fees from Vertex Pharmaceuticals; and travel support from Boehringer Ingelheim and Vertex Pharmaceuticals. M.A. Mall also reports advisory board participation for AbbVie, Antabio, Arrowhead, Boehringer Ingelheim, Enterprise Therapeutics, Kither Biotec, Pari and Vertex Pharmaceuticals and is a fellow of ERS (unpaid). P.J. McShane is an advisory board member for Boehringer Ingelheim's Airleaf trial and Insmed's Aspen trial. P.J. McShane is also a principal investigator for clinical trials with the following pharmaceutical companies: Insmed: Aspen, 416; Boehringer Ingelheim: Airleaf; Paratek: oral omadacycline; AN2 Therapeutics: epetraborole; Renovian: ARINA-1; Redhill; Spero; and Armata. K.G. Nielsen reports advisory board membership for Boehringer Ingelheim. M. Shteinberg reports having received research grants from Novartis, Trudell Pharma and GlaxoSmithKline; travel grants from Novartis, Actelion, Boehringer Ingelheim, GlaxoSmithKline and Rafa; speaker fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Insmed, Teva, Novartis, Kamada and Sanofi; and advisory fees (including steering committee membership) from GlaxoSmithKline, Boehringer Ingelheim, Kamada, Syncrony Medical, Zambon and Vertex Pharmaceuticals. M. Shteinberg also reports data and safety monitoring board participation for Bonus Therapeutics, Israel and is an ERS Task Force member on bronchiectasis guideline development. S.D. Sullivan has participated in advisory boards for Boehringer Ingelheim and has research grants from Pfizer, Bayer and GlaxoSmithKline. S.H. Chotirmall is on advisory boards for CSL Behring, Boehringer Ingelheim and Pneumagen Ltd, served on a data and safety monitoring board for Inovio Pharmaceuticals Inc., and has received personal fees from AstraZeneca and Chiesi Farmaceutici.

Support statement: This systematic literature review was funded by Boehringer Ingelheim International GmbH. The authors did not receive payment related to the development of the manuscript. Boehringer Ingelheim was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations. Funding information for this article has been deposited with the Crossref Funder Registry .

Received March 8, 2024.
Accepted June 4, 2024.

This version is distributed under the terms of the Creative Commons Attribution Licence 4.0.

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Oral lichen planus: a narrative review navigating etiologies, clinical manifestations, diagnostics, and therapeutic approaches.

1. Introduction

2. materials and methods, 3.1. etiology of oral lichen planus, 3.1.1. immunological links, 3.1.2. genetic predisposition, 3.1.3. environmental triggers, 3.1.4. microbial associations, 3.1.5. hormonal influence, 3.1.6. medications associated with drug-induced lichenoid reactions in oral lichen planus, 3.2. clinical presentation, 3.2.1. reticular olp, 3.2.2. erosive olp, 3.2.3. bullous olp, 3.2.4. atrophic olp, 3.2.5. plaque-like olp, 3.2.6. gingival involvement.

Plaque-like Lesions: These white or grayish lesions on the gingiva may be smooth or slightly raised, sometimes encircled by Wickham’s striae.
Ulcerative Lesions: Painful red or white ulcers can develop on the gingiva, either as single or multiple lesions, with varying depths.
Bullous Lesions: Though rare, gingival OLP can lead to blister formation on the gums which may easily rupture, causing painful ulcers [ 53 , 54 ].
Desquamative Lesions : Desquamative gingivitis, a hallmark presentation in OLP, manifests with erythematous and erosive gingival alterations, resulting in a desquamated appearance. It is characterized by erythema and occasional vesicle formation on the gingiva. While OLP is an autoimmune condition, plaque and bacterial build-up can exacerbate inflammation and potentially worsen desquamative gingivitis [ 55 ].

3.2.7. Associated Symptoms

3.3. diagnosis, 3.3.1. mucosal biopsy, 3.3.2. other tests.

OLP—A diagnosis of OLP requires fulfillment of both clinical and histopathological criteria.
Clinically typical of OLP but histopathologically only “compatible with” OLP.
Histopathologically typical of OLP but clinically only “compatible with” OLP.
Clinically “compatible with” OLP and histopathologically “compatible with” OLP [ 62 ].

3.4. Malignant Potential

3.5. treatment, 3.5.1. corticosteroids, 3.5.2. curcumin, 3.5.3. systemic therapies, 3.5.4. immunosuppressants, 3.5.5. retinoids, 3.5.6. laser therapy, 3.5.7. photodynamic therapy (pdt), 3.5.8. vitamin d, 3.5.9. biologics, 3.5.10. janus kinase inhibitors, 3.5.11. platelet-rich plasma, 3.5.12. other treatment options, 3.6. psychological impact, 3.7. limitations and future directions, 4. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest, abbreviations.

OLP	Oral Lichen Planus
WHO	World Health Organization
OSCC	Oral Squamous Cell Carcinoma
LP	Lichen Planus
VDR	Vitamin D Receptor
EOLP	Erosive Oral Lichen Planus
SDHB	Succinate Dehydrogenase Enzyme B
CB	Cathepsin B
EADV	European Academy of Dermatology and Venereology
PDT	Photodynamic Therapy
NB-UVB	Narrowband Ultraviolet B Therapy
HLA	Human Leukocyte Antigen
IL	Interleukin
TNF	Tumor Necrosis Factor
JAK	Janus Kinase
NSAID	Nonsteroidal Anti-Inflammatory Drug
ACE	Angiotensin-Converting Enzyme
MMP	Matrix Metalloproteinase
Th	T helper cells
Tc	T cytotoxic cells
iNOS	Inducible Nitric Oxide Synthase
HCV	Hepatitis C Virus
DIF	Direct Immunofluorescence
CBC	Complete Blood Count
Hb	Hemoglobin
LRT	Lichenoid Reactions to Drugs
RNA	Ribonucleic Acid
K-OLP	Keratotic Oral Lichen Planus
nK-OLP	Non-Keratotic Oral Lichen Planus
AML	Amlexanox
AV	Aloe Vera
CUR	Curcumin
PLA	Placebo
PUR	Purslane
SysCORT	Systemic Corticosteroid
TopCALN	Topical Calcineurin
TopCALNcoSysCORT	Topical Calcineurin combined with Systemic Corticosteroid
TopCORT	Topical Corticosteroid

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Click here to enlarge figure

Clinical Criteria	Histopathologic Criteria
Modified WHO diagnostic criteria of OLP and Oral Lichenoid Lesions (2003)
].	].
Diagnostic criteria by the American Academy of Oral and Maxillofacial Pathology, 2016 [ ]:
[ ]. [ ].	].

Criteria	Oral Lichen Planus (OLP)	Oral Lichenoid Lesions (OLL)
Etiology and Pathogenesis	Chronic mucocutaneous disease with possible autoimmune-related etiology.	Lesions with different etiologies, such as systemic medication, dental restorative materials, or food allergens.
Clinical Presentation	Typically bilateral and symmetrical lesions, often affecting the posterior buccal mucosa, tongue, and gingiva.	More commonly unilateral lesions that may be in close contact with dental restorations or other causative agents.
Histopathological Features	Well-defined band-like inflammatory infiltrate predominantly composed of lymphocytes, saw-toothed rete ridges, and hydropic degeneration of the basal cell layer.	Infiltrates with a poorly defined lower border in the subepithelial zone and presence of acute inflammatory cells such as eosinophils and neutrophils, deeper connective tissue infiltration, and hyperkeratosis.
Response to Removal of Trigger	No improvement with removal of external factors due to idiopathic nature.	Lesions often improve or resolve upon removal or modification of the causative factor (e.g., dental restoration or medication).
Diagnosis	Diagnosis based on clinical presentation and histopathological findings, confirmed by strict band-like infiltration and atrophic epithelium.	Diagnosis involves clinical presentation, history of potential triggers, histopathological examination, and presence of deep connective tissue infiltration and hyperparakeratosis [ ].

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Nukaly, H.Y.; Halawani, I.R.; Alghamdi, S.M.S.; Alruwaili, A.G.; Binhezaim, A.; Algahamdi, R.A.A.; Alzahrani, R.A.J.; Alharamlah, F.S.S.; Aldumkh, S.H.S.; Alasqah, H.M.A.; et al. Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches. J. Clin. Med. 2024 , 13 , 5280. https://doi.org/10.3390/jcm13175280

Nukaly HY, Halawani IR, Alghamdi SMS, Alruwaili AG, Binhezaim A, Algahamdi RAA, Alzahrani RAJ, Alharamlah FSS, Aldumkh SHS, Alasqah HMA, et al. Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches. Journal of Clinical Medicine . 2024; 13(17):5280. https://doi.org/10.3390/jcm13175280

Nukaly, Houriah Yasir, Ibrahim R. Halawani, Saja Mohammed S. Alghamdi, Araa Ghanem Alruwaili, Alhanouf Binhezaim, Rana Ali A. Algahamdi, Rayan Abdullah J. Alzahrani, Faisal Saad S. Alharamlah, Shahad Hamad S. Aldumkh, Hamad Majid A. Alasqah, and et al. 2024. "Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches" Journal of Clinical Medicine 13, no. 17: 5280. https://doi.org/10.3390/jcm13175280

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A narrative literature review is an integrated analysis of the existing literature used to summarize a body of literature, draw conclusions about a topic, and identify research gaps. By understanding the current state of the literature, you can show how new research fits into the larger research landscape.
The Structure and Conduct of a Narrative Literature Review
Writing a narrative literature review requires careful planning. This chapter summarizes some key steps in reviewing the literature. First, a team needs to be formed. Second, a topic needs to be chosen. This needs to be relevant to the author's research/teaching interests and a well-defined issue.
Narrative Review
Narrative Literature Reviews are works in which the author reviews a body of literature on a topic and synthesizes the information into a clear narrative that demonstrates the general context of the field. They can also be called a Traditional Literature Review. Compared to Systematic and Scoping reviews, Narrative literature reviews do not use ...
PDF Writing Narrative Literature Reviews
Writing Narrative Literature Reviews
Research Guides: Planning For Your Expert Literature Review: Narrative
Narrative or traditional literature reviews can take many shapes and forms. They do not need to follow any specific guideline or standard. A narrative literature view may be assigned as part of your coursework or capstone. A narrative literature review can be a first step to building on other research in the field.
Writing Narrative Literature Reviews
Abstract. Narrative literature reviews serve a vital scientific function, but few resources help people learn to write them. As compared with empirical reports, literature reviews can tackle broader and more abstract questions, can engage in more post hoc theorizing without the danger of capitalizing on chance, can make a stronger case for a ...
Literature Review: The What, Why and How-to Guide
Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified.
PDF Writing narrative literature reviews for peer-reviewed journals
Narrative Literature Review There are three types of narrative reviews of the literature: editorials, commentaries, and overview articles.4,15 Editorials, typically written by the editor of the jour-nal or an invited guest, may be a narrative review if the author retrieves and synthesizes information about a particular topic for the reader ...
How to Conduct a Systematic Review: A Narrative Literature Review
How to Conduct a Systematic Review: A Narrative ...
What is a literature review?
What is a literature review? - Literature Reviews
Writing narrative style literature reviews
A narrative review (Ferrari, 2015) using thematic analysis (Braun & Clarke, 2006) was chosen as the most appropriate approach to analyse, integrate, and summarise the literature on emotional ...
Traditional or Narrative Reviews
A narrative or traditional literature review is a comprehensive, critical and objective analysis of the current knowledge on a topic. They are an essential part of the research process and help to establish a theoretical framework and focus or context for your research. A literature review will help you to identify patterns and trends in the ...
How to Write a Literature Review
How to Write a Literature Review | Guide, Examples, & ...
Narrative Reviews in Medical Education: Key Steps for Researchers
Narrative Reviews in Medical Education: Key Steps for ...
Narrative Review
A narrative review is the type first-year college students often learn as a general approach. Its purpose is to identify a few studies that describe a problem of interest. Narrative reviews have no predetermined research question or specified search strategy, only a topic of interest. They are not systematic and follow no specified protocol.
Reviews: From Systematic to Narrative: Narrative Review
The labels Narrative Review and Literature Review are often describing the same type of review. For scientific purposes, the term Literature Review is the one used most often. For more information on the Literature Review, click on that link under the Review By Type tab.
LSBU Library: Literature Reviews: What is a Literature Review?
A literature review is an academic text that surveys, synthesizes, and critically evaluates the existing literature on a specific topic. ... Narrative Reviews: These provide a qualitative summary of the literature and are often used to give a broad overview of a topic. They may be less structured and more subjective, focusing on synthesizing ...
Narrative reanalysis: A methodological framework for a new brand of
Narrative review: Considers literature relevant to a specific topic and describes evidence with less emphasis on evaluation criteria and methodological matters than other forms of review. Narrative reanalysis: The method in which extracted data from an initial review is isolated further to focus on a specific sub-phenomenon. Traits of narrative ...
What is a Living Literature Review?
The number of academic papers doubles every 12 years. This wealth of new knowledge is exciting, but the pace of growth makes keeping up with the latest developments increasingly difficult. One response to this challenge is "living literature reviews". At Open Phil, we define a living literature review as a continuously updated online collection of […]
A systematic literature review of the clinical and socioeconomic burden
Search strategy. This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines [].Embase, MEDLINE and the Cochrane Library were searched for studies related to the clinical and socioeconomic burden of bronchiectasis (noncystic fibrosis bronchiectasis (NCFBE) and cystic fibrosis bronchiectasis (CFBE)) using ...
Nurse and pain in home palliative care: narrative review of the
METHODS: Literature narrative review on PubMed, Cochrane, CINAHL and EMBASE. The review was based on the steps and processes reported in the PRISMA standards for systematic reviews. The authors followed these steps: selection of the guiding question; definition of eligibility criteria; definition of relevant information deriving from studies ...
Narrative Reviews: Flexible, Rigorous, and Practical
A critical review is a narrative synthesis of literature that brings an interpretative lens: the review is shaped by a theory, a critical point of view, or perspectives from other domains to inform the literature analysis. Critical reviews involve an interpretative process that combines the reviewer's theoretical premise with existing theories ...
What is 'moral distress'? A narrative synthesis of the literature
Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis.
JCM
This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research. Methods: A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023 ...

Literature Review and Evidence Synthesis

What is a Narrative Literature Review

Subject Librarians

A narrative literature review is NOT:

Purposes of a narrative literature review:

1. Choose a topic & create a research question

2. Select the sources for searching & develop a search strategy

3. Conduct the search

4. Review the references

5. Summarize findings

For additional information :

Literature Review: Traditional or narrative literature reviews

The Literature Review

Writing your Literature Review

Need writing help? Head to the Graduate Writing Center for help with your literature review!

Staying Organized

Reference Management Research Guide

The Research Process

Drafting a Research Question

Conducting your Search

Books in the Libraries to Help with you Narrative Lit Review

Literature Review and Research Design: A Guide to Effective Research Practice

They Say / I Say: The Moves That Matter in Academic Writing, with Readings

The Literature Review: Six Steps to Success

Ask a Librarian

Planning For Your Expert Literature Review

Further Reading

Your Narrative Literature Review Should Have...

Literature Review: The What, Why and How-to Guide — Introduction

What are Literature Reviews?

Goals of Literature Reviews

Types of Literature Reviews

Literature Reviews in the Health Sciences

How to Conduct a Systematic Review: A Narrative Literature Review

Sadiq Naveed

Muhammad Zeshan

Muhammad A Tahir

Introduction and background

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) checklist

Research question

Inclusion and exclusion criteria

Protocol registration

Using Boolean operators, truncation, and wildcards

Study selection

Assessing bias

Last step of systematic review: discussion

Discussion of the current article

Conclusions

Literature Reviews

What is a Literature Review?

Purpose of a Literature Review

Limitations of a Literature Review

Librarian Assistance

How to Conduct a Literature Review: A Guide for Graduate Students

Traditional or Narrative Reviews

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How to Write a Literature Review | Guide, Examples, & Templates

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Table of contents

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Make a list of keywords

Search for relevant sources

Take notes and cite your sources

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Chronological

Methodological

Theoretical

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Literature Reviews

What is a Living Literature Review?

Privacy Overview

A systematic literature review of the clinical and socioeconomic burden of bronchiectasis

Search strategy

Selection criteria

Screening and data extraction

Summary of included studies

Clinical burden

Disease severity