Clinical Review

Treatment of bronchiectasis in adults

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39384.657118.80 (Published 22 November 2007) Cite this as: BMJ 2007;335:1089
  1. Nick H T ten Hacken, specialist registrar in pulmonology,
  2. Peter J Wijkstra, specialist registrar in pulmonology,
  3. Huib A M Kerstjens, professor of pulmonology
  1. Pulmonary Department, University Medical Centre Groningen, University of Groningen, Postbox 30001, 9700 RB Groningen, Netherlands
  1. Correspondence to: N H T ten Hacken n.h.t.ten.hacken{at}int.umcg.nl

    Summary points

    • Bronchiectasis refers to abnormal bronchial dilatation caused by a vicious cycle of transmural infection and inflammation

    • Symptoms include chronic productive cough, wheeze, and dyspnoea; repeated respiratory infections may dominate the clinical picture

    • Diagnosis is based on daily production of mucopurulent phlegm and dilated and thickened airways on computed tomography

    • Diagnosis should lead to investigation and treatment of possible causes and associated conditions

    • Acute exacerbations should be treated promptly with short courses of antibiotics

    • Frequent exacerbations may be treated with prolonged and aerosolised antibiotics

    • The role of mucolytics, anti-inflammatory agents, and bronchodilators is not clear

    • Surgery is a possibility if the area of bronchiectasis is localised and symptoms are debilitating or life threatening

    Patients with bronchiectasis usually need lifelong medical support from their doctor, especially given the frequent episodes of infection. This article focuses on the treatment of bronchiectasis in adults and does not include a discussion of bronchiectasis caused by cystic fibrosis. The prevalence of bronchiectasis not linked to cystic fibrosis is unclear, but every general practitioner in the United Kingdom probably has a few patients.

    How do we diagnose bronchiectasis?

    Bronchiectasis refers to the permanent abnormal dilatation of the central and medium sized bronchi as a result of a vicious cycle of transmural infection and inflammation with mediator release.1 Symptoms include chronic productive cough, wheeze, and dyspnoea. Infective exacerbations are associated with worsening of symptoms and signs of pneumonia. Haemoptysis can occur, but amounts of blood are usually small, and serious haemoptysis requiring selective arteriography and embolisation or surgery is rare.

    The most frequently used classification system distinguishes between cylindrical, varicose, and saccular or cystic bronchiectasis.w1 Although insightful, this classification has no clinical or therapeutic uses. A modern clinical definition includes the daily production of mucopurulent phlegm and chest imaging that demonstrates dilated and thickened airways.w2 The clinical suspicion of bronchiectasis …

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