From the Guidelines
Bronchiectasis is a chronic lung condition characterized by permanent widening and damage of the airways (bronchi), leading to impaired mucociliary clearance, chronic bronchial infection, and inflammation, which can result in significant morbidity, mortality, and impaired quality of life 1.
Definition and Pathophysiology
Bronchiectasis is defined by the presence of both permanent bronchial dilatation on computed tomography (CT) scanning and the clinical syndrome of cough, sputum production, and/or recurrent respiratory infections 1. The condition is often associated with chronic airways infection, most frequently with Haemophilus influenzae and Pseudomonas aeruginosa, which can stimulate and sustain lung inflammation 1.
Symptoms and Complications
Common symptoms of bronchiectasis include persistent cough with thick mucus production, shortness of breath, wheezing, chest pain, fatigue, and recurrent respiratory infections 1. Exacerbations of bronchiectasis are key targets for therapy, as they are major determinants of healthcare costs and are associated with increased airways and systemic inflammation, progressive lung damage, and worse quality of life 1.
Treatment and Management
Treatment of bronchiectasis focuses on managing symptoms and preventing complications through airway clearance techniques, antibiotics for infections, bronchodilators to open airways, and anti-inflammatory medications 1. The goals of treatment are to improve quality of life, reduce symptoms, and prevent future complications such as lung function decline and severe exacerbations 1.
Key Considerations
It is essential to take into account the patient's values and preferences in all treatment decisions, alongside the history of exacerbations, quality of life, severity of disease, and underlying aetiology, all of which can impact on the patient's long-term outcome 1. The economic burden of bronchiectasis is significant, and treatment decisions must balance the potential beneficial effects of the intervention against the burden of treatment and the risk of adverse events 1.
Recommendations
The management of bronchiectasis should prioritize reducing exacerbations, improving quality of life, and slowing disease progression, with a focus on individualized treatment plans that take into account the patient's unique clinical circumstances and preferences 1.
From the Research
Definition and Characteristics of Bronchiectasis
- Bronchiectasis is characterized by permanent, abnormal dilation of the bronchi with chronic inflammation and infection 2
- It is either caused by or associated with several systemic disorders, and in a significant number of cases, the underlying etiology remains unidentified and is subsequently referred to as idiopathic 2
- The clinical course is characterized by chronic cough with purulent sputum associated with acute exacerbations 2
Diagnosis and Treatment
- The confirmatory diagnosis of bronchiectasis can be made promptly with high-resolution computed tomography, and diagnostic work-up for etiology initiated 2
- Identifying a specific etiology, when present, is critical for implementing appropriate treatment of the underlying cause 2
- Management of bronchiectasis requires addressing infection, inflammation, and bronchial toilet, regardless of the underlying etiology 2
- Antibiotics are an essential component of the management of patients with bronchiectasis, including treatment of exacerbations, maintenance therapy to reduce exacerbation frequency, and eradicating potentially harmful organisms 3
Treatment Options
- Airway clearance techniques, mucoactive agents, and pulmonary rehabilitation are used in the treatment of patients with bronchiectasis 4
- Long-term inhaled antibiotics and/or oral macrolides are recommended as part of patient management 5
- Azithromycin has been shown to reduce sputum volume, improve quality of life, and stabilize lung function in patients with bronchiectasis 6