Bronchiectasis

Bronchiectasis often presents with recurrent pulmonary infections, including a chronic daily productive cough with mucopurulent sputum production.

High-resolution chest computed tomography is the confirmatory test.

Diagnostic testing is geared towards identifying the underlying aetiology, as treatment will be successful only if it treats both the bronchiectasis and any underlying disease process.

A sputum sample should be obtained when the patient is in a stable state and during acute exacerbations. Antibiotics are used in three scenarios: to treat acute exacerbations, eradication of a first or new isolation of Pseudomonas aeruginosa, and long-term antibiotics to suppress chronic bacterial infection. Where possible, antibiotic choice should be based on culture and sensitivity from sputum samples.

Daily airway clearance is essential for treatment success.

Exercise training is often offered as part of a pulmonary rehabilitation programme, combined with patient education and training in self-management, and delivered on an outpatient basis or remotely via telerehabilitation. Self-management plans aim to increase patients' confidence in managing their own condition.

Maintenance aerosolised antibiotics may be used for treatment of severe bronchiectasis or recurrent Pseudomonas aeruginosa infections.

Surgical therapy, including lung transplantation, should be considered for adult patients who continue to deteriorate despite optimal medical management, but is rarely undertaken in children.

Bronchiectasis is the abnormal dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall.[1]Laennec RT. A treatise on the disease of the chest. Forbes J, trans. New York, NY: Macmillan (Hafner Press);1962:78.[2]Reid LM. Reduction in bronchial subdivision in bronchiectasis. Thorax. 1950 Sep;5(3):233-47. https://thorax.bmj.com/content/5/3/233.long http://www.ncbi.nlm.nih.gov/pubmed/14776716?tool=bestpractice.com It is often caused as a consequence of recurrent and/or severe infections secondary to an underlying disorder. The majority of patients will present with a chronic cough and sputum production.[3]Rosen MJ. Chronic cough due to bronchiectasis: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 suppl):122S-31S. https://journal.chestnet.org/article/S0012-3692(15)52840-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/16428701?tool=bestpractice.com [4]Barker AF. Bronchiectasis. New Engl J Med. 2002 May 2;346(18):1383-93. http://www.ncbi.nlm.nih.gov/pubmed/11986413?tool=bestpractice.com

This topic covers the diagnosis and management of non-cystic fibrosis bronchiectasis in children, adolescents, and adults. For detailed information on the treatment of cystic fibrosis, see Cystic fibrosis.