Bronchiectasis

Definition/diagnostic criteria Bronchiectasis is a chronic condition characterised by permanent dilation and damage to the bronchi, often caused by a cycle of infection and inflammation. The most common cause is previous severe lower respiratory tract infection. Other causes include aspiration, COPD/asthma, tumours and connective tissue disorders.

Diagnostic criteria include clinical features combined with radiological confirmation, typically through high-resolution computed tomography (HRCT) scans showing bronchial dilation, lack of tapering of bronchi and bronchial wall thickening.

Epidemiology The prevalence of bronchiectasis in the UK is increasing, possibly due to ageing populations and improved diagnostic methods. It’s more common in older adults and slightly more prevalent in women. Cystic fibrosis-related bronchiectasis remains a significant subset, although non-cystic fibrosis bronchiectasis is more common in the general population.

Diagnosis
Clinical features: Bronchiectasis presents with chronic productive cough, recurrent respiratory infections, dyspnoea, and haemoptysis. Other symptoms include fatigue, chest pain and wheezing. It’s essential to differentiate it from conditions like COPD and asthma.

Investigations: Initial investigations include a chest X-ray, although HRCT is the gold standard for diagnosis. Spirometry is used to assess lung function. Full blood count, serum immunoglobulins and sputum cultures help identify underlying causes and secondary infections. Bronchoscopy may be considered in specific cases, particularly where there is suspicion of foreign body or tumour.

Treatment Management of bronchiectasis is primarily focused on symptom control and preventing exacerbations. Treatment includes:

• Airway clearance techniques: encouraging patients to perform regular chest physiotherapy.
• Advise smoking cessation as appropriate.
• Pharmacotherapy: inhaled bronchodilators and corticosteroids are used in some cases. Long-term antibiotics, either oral or inhaled, may be required for frequent exacerbations or chronic infection.
• Management of exacerbations: prompt antibiotic treatment (7-14 days) based on sputum culture results. Consideration of intravenous antibiotics in severe cases.
• Vaccinations: immunisation against influenza and penumonia.
• Referral to specialist care: considered for patients with complex disease, frequent exacerbations or those requiring assessment for surgical intervention.
• Oxygen therapy may be needed in some.

Prognosis The prognosis of bronchiectasis varies, depending on the severity, underlying causes and comorbidities. Patients are at an increased risk of recurrent infections and may experience a gradual decline in lung function. Early diagnosis and appropriate management can help control symptoms, reduce exacerbations and improve quality of life.