Bronchiectasis: New Approaches to Diagnosis and Management
Section snippets
Prevalence of bronchiectasis
The true prevalence of bronchiectasis is unknown for most regions of the world. There is a commonly held belief that, with the advent of vaccination that effectively prevents many serious childhood respiratory illnesses, as well as the ready availability of potent antibiotics that rapidly treat acute respiratory tract infections, bronchiectasis is on the decline.5 Studies have reported an incidence of bronchiectasis in Finland of 3.9 per 100,000 per year in the overall population (0.49 per
Causes and pathogenesis
A detailed description of the pathophysiology and associated causes of bronchiectasis is beyond the scope of this article, but has been extensively reviewed elsewhere.11, 12, 13, 14, 15 Bronchiectasis results from the occurrence of one of three main pathogenic mechanisms: bronchial wall injury, bronchial lumen obstruction, and traction from adjacent fibrosis.14 The dominant feature of bronchiectasis is clearly the presence of airway inflammation, in association with bacterial infection, and, in
Diagnosis
The diagnosis of bronchiectasis should be suspected in any individual presenting with persistent daily cough with mucopurulent sputum.22 Interestingly, it is said that sputum volume correlates with quality of life and the lung function decline in patients with bronchiectasis.23 Furthermore, the Leicester Cough Questionnaire (LCQ), a symptom-specific questionnaire designed to assess the impact of cough severity, has been found reliable for use in patients with non-CF bronchiectasis. It can
Management
A myriad of treatment options are potentially available for the management of patients with bronchiectasis, but only a limited number of studies have investigated these options in non-CF cases. Many of them included small numbers of patients and few were randomized or blinded.15, 31, 32 Many of the current recommendations are based on studies and recommendations in patients with CF and extrapolation from the management of other respiratory conditions, or based on expert opinion.21 The general
Prognosis
In the pre-antibiotic era, the mortality rate in patients with bronchiectasis was estimated to be greater than 25%, but this has undoubtedly improved with the advent of antibiotics, although it still remains significant and further investigations are clearly required to better define the natural history of the condition.101 Bronchiectasis morality appears to be up to 13% over a 5-year follow-up period and patients of older age with chronic hypoxia, hypercapnia, and greater radiological extent
Summary
The purpose of this article is to review the subject of bronchiectasis with the emphasis on new aspects of diagnosis and management. A summary of the main findings in this regard are as follows:
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Thin-slice HRCT of the chest is considered to be the gold standard for the diagnosis of bronchiectasis
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Because of concerns of the level of radiation exposure with HRCT, particularly in children, MRI has been studied more recently for the diagnosis of bronchiectasis and been found to be a potentially
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Financial disclosure: The author has nothing to disclose.