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. 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.
History and exam
- cystic fibrosis
- host immunodeficiency
- previous infections
- congenital disorders of the bronchial airways
- primary ciliary dyskinesia
- alpha-1 antitrypsin deficiency
- connective tissue disease
- inflammatory bowel disease
- aspiration or inhalation injury
- focal bronchial obstruction
- tall, thin, white females, age 60 or over
- high-resolution chest CT
- sputum culture and sensitivity
- serum alpha-1 antitrypsin phenotype and level
- serum immune globulins
- sweat chloride test
- rheumatoid factor
- Aspergillus fumigatus skin prick test
- serum HIV antibody
- nasal nitric oxide (NNO)
- pulmonary function tests
Professor of Medicine
Chief, Division of Pulmonary, Critical Care and Sleep Medicine
Georgetown University Hospital
AEOD has been compensated by the following companies for consultation regarding new drug development and clinical trials: Bayer, Xellia, Novartis, Insmed. AEOD has been or is the Principal Investigator for trials sponsored by the following companies (research funding provided directly to Georgetown University): Bayer, Insmed, Aradigm, Gilead. AEOD is the Principal Investigator for the Bronchiectasis Research Registry, sponsored by the COPD Foundation (research funding provided directly to Georgetown University). AEOD is the author of a reference cited in this monograph.
Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this monograph. PJM and SMB declare that they have no competing interests.
Honorary Senior Lecturer
Imperial College Healthcare Trust
PWI declares that he has no competing interests.
Associate Professor of Medicine
US Department of Veterans Affairs
Palo Alto Health Care System
WK declares that he has no competing interests.
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