Bronchiectasis

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

Diagnostic testing for a potential etiology of unexplained bronchiectasis should be performed.

A sputum sample should be obtained when the patient is in a stable state and during acute exacerbations. Systemic antibiotics directed toward prior culture results should be administered.

Daily airway clearance is essential for treatment success.

Maintenance aerosolized antibiotics should be used for treatment of severe bronchiectasis or recurrent Pseudomonas aeruginosa infections.

Surgical therapy, including lung transplantation, should be considered for patients who continue to deteriorate despite optimal medical management.

Bronchiectasis is the permanent 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;5:233-247. http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1018338&blobtype=pdf 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;129(1_Suppl):122S-131S. http://journal.publications.chestnet.org/article.aspx?articleid=1084246 http://www.ncbi.nlm.nih.gov/pubmed/16428701?tool=bestpractice.com [4] Barker AF. Bronchiectasis. New Engl J Med. 2002;346:1383-1393. http://www.ncbi.nlm.nih.gov/pubmed/11986413?tool=bestpractice.com