What are the complications of bronchiectasis?

Complications of Bronchiectasis

Bronchiectasis can lead to numerous serious complications including recurrent respiratory infections, hemoptysis, respiratory failure, and increased mortality, particularly in patients with frequent exacerbations and Pseudomonas aeruginosa infection. 1

Respiratory Complications

Recurrent Infections and Exacerbations

• Frequent exacerbations (≥3 per year) are associated with:
  • Progressive lung function decline 1
  • Decreased quality of life 1
  • Increased mortality 1
• Approximately 50% of European bronchiectasis patients have ≥2 exacerbations per year 1
• One-third require at least one hospitalization annually 1

Chronic Bronchial Infection

• Common pathogens include:
  • Haemophilus influenzae
  • Pseudomonas aeruginosa (associated with 3-fold increase in mortality risk and 7-fold increase in hospitalization risk) 1
  • Moraxella catarrhalis
  • Staphylococcus aureus
  • Enterobacteriaceae 1
• Less common but significant pathogens:
  • Nocardia asteroides
  • Aspergillus species
  • Alcaligenes xylosoxidans
  • Mycobacterium species 1

Hemoptysis

• Can range from mild to massive and potentially life-threatening 1
• Recurrent refractory or massive hemoptysis may require surgical intervention 1

Respiratory Failure

• Progressive airflow obstruction can lead to respiratory failure 1
• More than 50% of patients have airflow obstruction, but restrictive and mixed ventilatory patterns also occur 1

Systemic and Vascular Complications

Cardiovascular Disease

• Increased risk of coronary heart disease (HR 1.44,95% CI 1.27-1.63) 1
• Increased risk of stroke (HR 1.71,95% CI 1.54-1.90) 1
• Moderate or worse bronchiectasis severity is an independent risk factor for vascular disease 1

Pulmonary Hypertension

• Associated with increased mortality (HR 1.24,95% CI 1.13-1.35) 1
• More common in patients with cystic bronchiectasis 1
• Associated with poorer ventilatory function 1

Lung Cancer

• Evidence is mixed:
  • One study showed increased risk (adjusted HR 2.36,95% CI 2.19-2.35) in patients hospitalized with bronchiectasis 1
  • Another study suggested lower prevalence of bronchiectasis in COPD patients with lung cancer compared to those without (OR 0.25,95% CI 0.12-0.52) 1

Pain and Quality of Life Impact

Chest Pain

• Common during exacerbations 1
• May co-localize with bronchiectasis position on CT scan 1
• Often occurs early in exacerbations and subsides during recovery 1
• Associated with consolidation, collapse, or atelectasis in some cases 1

Quality of Life Impairment

• Chronic symptoms (daily cough, sputum production) 2
• Fatigue, especially during exacerbations 2
• Breathlessness due to airflow obstruction, impaired gas transfer, and exercise deconditioning 1

Surgical Complications

For patients requiring surgical intervention, complications include:

• Early post-operative complications (13-24% morbidity rate):
  • Wound infection (most common, 6% in one large series) 1
  • Empyema
  • Systemic sepsis
  • Post-thoracotomy pain
  • Prolonged air leak 1
• 60-day mortality ranges from 0-11% 1
• Recurrence of bronchiectasis, particularly with incomplete resection 1

Prognostic Factors

Factors associated with worse outcomes and increased mortality:

• Frequent and severe exacerbations 2
• Pseudomonas aeruginosa infection 2
• Comorbidities, particularly COPD 2
• Breathlessness 1
• Immunocompromised status 1
• Extent of residual bronchiectasis after surgery 1

Conclusion

Bronchiectasis is associated with significant morbidity and mortality, with complications affecting both respiratory and non-respiratory systems. Early recognition and appropriate management of these complications are essential to improve outcomes and quality of life for patients with bronchiectasis.