What is the diagnosis and treatment for Bronchiectasis?

From the Guidelines

Bronchiectasis should be managed with a comprehensive approach focusing on preventing exacerbations, clearing mucus, and treating infections, with the goal of improving quality of life and stopping disease progression. This chronic lung condition is characterized by permanent widening of the airways (bronchi), leading to mucus buildup and recurrent infections, and occurs when the walls of the airways become damaged and scarred, often due to repeated infections, autoimmune disorders, genetic conditions like cystic fibrosis, or aspiration 1. Management strategies include daily airway clearance techniques, such as postural drainage, chest physiotherapy, and devices like flutter valves or positive expiratory pressure devices, as well as antibiotics prescribed based on sputum culture results for acute exacerbations 1.

Key Components of Management

• Daily airway clearance techniques to prevent mucus stasis and associated complications
• Antibiotics for acute exacerbations, with consideration of preventive therapy for frequent exacerbations
• Inhaled bronchodilators to help with airflow
• Mucolytics to thin secretions
• Addressing the underlying cause, maintaining hydration, and receiving pneumococcal and annual influenza vaccinations

Treatment Recommendations

• For acute exacerbations, antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 14 days), azithromycin (500 mg daily for 7-10 days), or ciprofloxacin (500-750 mg twice daily for 14 days) may be prescribed based on sputum culture results 1
• For patients with frequent exacerbations, macrolide antibiotics like azithromycin (250-500 mg three times weekly) may be used as preventive therapy 1
• Inhaled bronchodilators such as albuterol (2-4 puffs every 4-6 hours as needed) can help with airflow, while mucolytics like hypertonic saline (3-7% solution inhaled twice daily) or N-acetylcysteine may thin secretions 1

Pulmonary Rehabilitation

• Adult patients with bronchiectasis and impaired exercise capacity should participate in a pulmonary rehabilitation programme and take regular exercise, with the aim of improving exercise tolerance and quality of life through a tailored standardised exercise protocol 1
• Pulmonary rehabilitation has a clear impact on exercise capacity immediately after the programme and a nonsignificant trend to improved quality of life (SGRQ) 1

From the Research

Diagnosis of Bronchiectasis

• Bronchiectasis is a chronic lung condition characterized by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance 2
• The disease is often identified in patients with other lung diseases, such as chronic obstructive pulmonary disease, asthma, and in a lesser but not insignificant number of patients with other inflammatory diseases, such as rheumatoid arthritis and inflammatory bowel disease 3

Treatment of Bronchiectasis

• The overall goals of therapy are to prevent exacerbations, improve symptoms, improve quality of life and preserve lung function 3
• Treatment plans should include both pharmacological and non-pharmacological treatments, such as airway clearance techniques, inhaled antibiotics, long-term macrolide therapy, and pulmonary rehabilitation 2, 4, 5
• Patient education and cooperation with health-care providers to implement treatment plans are key to successful disease management 3
• The treatment of bronchiectasis in adults is based on several pillars, including treatment of the etiology, treatment of bronchial colonization or infection, treatment of bronchial secretions, treatment of bronchial inflammation and hyperresponsiveness, treatment of systemic manifestations, treatment of exacerbations, treatment of complications, and surgical treatment 6

Management Strategies

• Airway clearance techniques and hyperosmolar agents are key components of bronchiectasis management and consistently recommended for clinical implementation 2
• Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis, particularly during a clinically stable stage of the disease 2
• Self-management programmes feature prominently in bronchiectasis treatment, but the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base 2
• Prompt treatment of exacerbations with antibiotic therapy is important to limit the impact of exacerbations on quality of life and lung function decline 3